Enrollment Quality Assurance Analyst

Network Health; Town of Brookfield (WI); Hybride; USD 65 000 - 90 000; Plein temps

Résumé du poste

Network Health in Wisconsin seeks an Enrollment Quality Assurance Analyst to monitor and evaluate enrollment data, identify quality gaps, ensure compliance, and support MAR and related audits. The role partners with Internal Audit to drive corrective actions and continuous process improvements in enrollment operations.

The position supports monitoring, reporting, and process improvements across regulatory standards while collaborating with enrollment and QA teams.

Qualifications

• 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.

Responsabilités

• 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 CMS, OCI, 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.

Description du poste

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.

TheEnrollment 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

Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference.

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.