Enrollment Quality Assurance Analyst
About The Position
The Enrollment Quality Assurance Analyst monitors and evaluates operational data to identify quality gaps, ensure compliance, and improve enrollment processes and service. The role conducts internal audits in support of Model Audit Requirements (MAR) and Service Level Agreements, partnering with Internal Audit as needed. It also helps resolve complex issues, supports core department functions, and maintains desk-level procedures. Through ongoing monitoring of enrollment transactions, the analyst identifies trends and root causes, recommends corrective actions, and supports continuous process improvement to strengthen accuracy, compliance, and operational performance. The position is open to candidates who reside in Wisconsin. Work may be performed from a home office with reliable internet, at the Brookfield or Menasha office, or through the company’s hybrid workplace model. The schedule is 1.0 FTE, 40 hours per week, 8 a.m. to 5 p.m., Monday through Friday.
Requirements
- High school diploma or equivalent.
- At least 2 years of experience in an auditing-focused role.
- At least 2 years of experience in health care.
- Must reside in Wisconsin.
Responsibilities
- Demonstrate commitment and behavior aligned with Network Health’s philosophy, mission, values, and vision.
- Apply organizational and regulatory principles, procedures, requirements, regulations, and policies appropriately.
- Support and regularly review department policy and procedure documents for regulatory compliance, operational efficiency, and alignment with industry best practices; identify gaps and partner with leadership and/or trainers on process improvements.
- Promote collaboration between enrollment and quality assurance staff, including effective monitoring, acknowledgment of feedback, and correction of errors.
- Collaborate with compliance staff, regulatory contacts, and software vendors on high-priority questions and issues.
- Track and trend audit results to identify and pursue improvement opportunities.
- Contribute expertise to monitoring activities, including CMS, OCI, MAR controls, HEDIS audits, and Enrollment Data Validation (EDV).
- Identify process gaps and partner with internal stakeholders to address and resolve them.
- Provide accurate and timely reporting according to department, regulatory, and business requirements.
- Maintain knowledge of current state, federal, and industry regulatory standards and service expectations.
- Communicate process issues, resource needs, and training opportunities to department leadership.
- Perform audits according to department standards and partner with leadership and stakeholders on root cause analysis and corrective action plans as needed.
- Assist with monitoring department phone lines and email inboxes and coordinating staff coverage.
- Perform other duties as assigned.
Benefits
- Opportunity to get paid to volunteer in the local community.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
