QA Analyst

General Dynamics•Silver Spring, MD

29d•$62,962 - $78,200•Remote

About The Position

The Affordable Care Act (ACA) requires every state to establish a health insurance exchange (also called Health Insurance MarketplaceSM) to facilitate the purchase of health insurance for individuals and small businesses. Through the Center of Program Integrity (CPI), CMS has strong oversight and internal controls to protect consumers enrolled in the Marketplaces and safeguard taxpayer dollars. CMS develops and enforces rules for insurance agents, brokers, and others who assist with FFM enrollments. The Marketplace Program Integrity Contract (MPIC) is designed to support this oversight. Through research, investigation, and data analysis, the desired outcomes of the MPIC efforts are to prevent, detect, and resolve noncompliance with Marketplace rules, requirements, and laws; recommend administrative actions to CMS; and recommend referrals to law enforcement if potential fraud and abuse is identified. Summary: This position will develop and apply quality standards in accordance with GDIT, MPIC, and customer requirements. Develops and conducts related reviews and development of processes. Ensures compliance is followed throughout quality assurance process. Coordinates and collaborates with internal and external partners to ensure quality standards are met and to establish standards. Reviews and edits materials to ensure grammar, content, and formatting are accurate and compliant. Additional work can include attending meetings and maintaining/developing associated documentation and collecting/maintaining staff training materials and annual certifications.

Requirements

Bachelor's degree or equivalency in healthcare field that includes 2-4 years' ACA and/or Medicaid-Medicare experience
2 or more years' experience with conducting documentation quality assurance, including editing, reviewing, and writing.
Frequent work with workgroups to successful completion of goals and milestones
Highly organized, ability to multi-task, and meet deadlines
Proficient in computer skills, for example Microsoft Office-Word, Excel
Requires only limited oversight to conduct work
Strong interpersonal and communications skills, both written and oral
Candidate must meet the residency requirement of having lived in the US for three (3) of the past five (5) years and pass a CMS background check.

Nice To Haves

Experience with FWA claims and investigations
Experience with and/or understanding of ACA policies and regulations related to consumer enrollments requirements and Agent/Broker and Navigator responsibilities

Responsibilities

Contributes to the completion of quality assurance projects.
Strictly follow approved Standard Operating Procedures (SOPs) and related guidance and provide input into recommendations for SOP and guidance updates as needed.
Reviews and edits material for punctuation, grammar, and content.
Identifies and modifies contextual errors, reorganizes content, and edits graphics, tables, and illustrations.
Assesses potential risks and compliance issues and provides recommendations.
Implements quality standards and executes compliance on every stage of the process.
Liaises with internal and external partners to ensure products or services meet the organization's quality standards, including collaborating closely with technical teams to deliver appropriate and complex content.
Monitors and develops quality assurance strategies, including developing the process for crafting and refining of ideas, cultivating sources, and developing highly articulate articles.
As needed, coordinates and performs quality trainings and documents the entire quality testing process.
As needed, attends meetings and maintains/develops associated documentation.
Safeguard PII and PHI
Infrequent travel may be required

Benefits

401K with company match
Comprehensive health and wellness packages
Internal mobility team dedicated to helping you own your career
Professional growth opportunities including paid education and certifications
Cutting-edge technology you can learn from
Rest and recharge with paid vacation and holiday
Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee's date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.

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