Enrollment Quality & Compliance Auditor

Network Health; Menasha (WI); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Hybrid work model

Volunteer time for community service

Job summary

Network Health in Wisconsin is seeking an Enrollment Quality Assurance Analyst to monitor and evaluate enrollment data, identify quality gaps, and drive compliant enrollment processes. You will perform internal audits supporting MAR and service agreements, collaborating with Internal Audit as needed.

This role emphasizes trend analysis, root cause investigation, and corrective action planning, with responsibilities across CMS, OCI, MAR controls, and EDV.

Qualifications

• Minimum of 2 years in an auditing-focused role.
• Minimum of 2 years of experience in health care.
• Knowledge of enrollment data processes and compliance standards is a plus.

Responsibilities

• Demonstrate commitment to Network Health's mission.
• Ensure regulatory compliance and operational efficiency through policy reviews.
• Support monitoring practices and collaborate with leadership to implement improvements.
• Coordinate with compliance staff and software vendors on high-priority issues.
• Track audit results and pursue improvement opportunities.
• Serve as SME for CMS, OCI, MAR controls, HEDIS audits, and EDV.
• Identify process gaps and work with stakeholders to resolve them.
• Provide timely department reporting.
• Maintain current regulatory knowledge.
• Communicate concerns to leadership.
• Assist in monitoring phone lines and email inboxes.
• Perform other duties as assigned.

Skills

Auditing

Regulatory compliance

Data analysis

Education

High school diploma or equivalent

Job description

Network Health in Wisconsin is seeking an Enrollment Quality Assurance Analyst to monitor and evaluate enrollment data, identify quality gaps, and drive compliant enrollment processes. You will perform internal audits supporting MAR and service agreements, collaborating with Internal Audit as needed.

This role emphasizes trend analysis, root cause investigation, and corrective action planning, with responsibilities across CMS, OCI, MAR controls, and EDV.