Enrollment Quality Assurance Analyst

Brookfield; Menasha, Town of Brookfield (WI, WI); Hybrid; USD 55,000 - 75,000; Full time

Job summary

Network Health is seeking an Enrollment Quality Assurance Analyst to monitor and evaluate enrollment data, identify quality gaps, ensure compliance, and drive improvements across enrollment processes. This role conducts internal audits in support of MAR and service level agreements, partnering with Internal Audit as needed.

Candidates reside in Wisconsin and may work from home, at our Brookfield or Menasha offices, or a hybrid mix.

Qualifications

• 2+ years in an auditing-focused role.
• 2+ years of health care experience.
• Strong knowledge of regulatory standards.

Responsibilities

• Demonstrates commitment and behavior aligned with Network Health's mission and values.
• Applies organizational and regulatory principles, procedures, requirements, and policies.
• Supports and reviews department policy to ensure regulatory compliance and operational efficiency; partners to implement improvements.
• Collaborates with enrollment and quality assurance staff to promote effective monitoring and address errors.
• Coordinates with compliance staff, regulatory contacts, and software vendors for high-priority questions.
• Tracks and trends audit results to identify opportunities for improvement and corrective actions.
• Acts as a subject matter expert for CMS, OCI, MAR controls, HEDIS audits, and EDV data validation.
• Identifies process gaps and works with stakeholders to resolve them.
• Provides accurate reporting per department and regulatory requirements.
• Keeps knowledge current on state, federal, and industry regulatory standards.
• Raises concerns to leadership about processes and resource needs.
• Performs audits per department standards and supports root-cause analysis and corrective action plans.
• Assists in monitoring department phone lines and email inboxes, coordinating staff coverage.
• Performs other duties as assigned.

Skills

Auditing

Regulatory compliance

Data analysis

Problem solving

Education

High school diploma or equivalent

Job description

Network Health’s success is deeply rooted in its mission to build healthy and strong Wisconsin communities. This mission shapes every decision we make, including the selection of individuals who join our growing team. The Enrollment Quality Assurance Analyst is responsible for monitoring and evaluating operational data to identify quality gaps, ensure compliance, and drive best-in-class enrollment processes and service. This role conducts internal audits in support of Model Audit Requirements (MAR) and Service Level Agreements, partnering with Internal Audit as needed. The position plays a key role in resolving complex issues, supporting primary department functions, and maintaining department 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 enhance accuracy, compliance, and operational performance. Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both with our hybrid workplace model. Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday

Job Responsibilities

• Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health
• Appropriately apply all organizational and regulatory principles, procedures, requirements, regulations, and policies
• Supports and regularly reviews department policy and procedure documents to ensure regulatory compliance, operational efficiency, and alignment with industry best practices; identifies gaps and partners with department leadership and/or trainers to implement process improvements.
• Supports collaboration between enrollment and quality assurance staff to promote effective monitoring practices, ensure feedback is acknowledged, and errors are corrected.
• Supports collaboration with compliance staff, regulatory contacts, and software vendors as high-priority questions and issues arise.
• Supports tracking and trending of audit results to identify and pursue improvement opportunities.
• Serves as a subject matter expert and key contributor for monitoring activities, including Centers for Medicare & Medicaid Services (CMS), Office of the Commissioner of Insurance (OCI), Model Audit Rule (MAR) controls, HEDIS audits, and Enrollment Data Validation (EDV).
• Identifies process gaps and partners with internal stakeholders to address and resolve them.
• Provides accurate and timely reporting in accordance with department, regulatory, and business requirements.
• Maintains knowledge of current state, federal, and industry regulatory standards and service expectations.
• Communicates concerns to department leadership, including process issues, resource needs, and training opportunities.
• Performs audits per department standards and partners with leadership and appropriate stakeholders to support root cause analysis and development of corrective action plans as needed.
• Assists in monitoring department phone lines and email inboxes, helping coordinate staff coverage.
• Performs other duties as assigned.

Job Requirements

• High school diploma or equivalent
• 2 or more years working in an auditing focused role required.
• 2 or more years of experience in health care required.

Network Health is an Equal Opportunity Employer

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.