QA Review Specialist - Public Programs & Payments

GoFusion; Baltimore, Northern (MD, KY); Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical, dental & vision coverage

Job summary

Fusion Advanced Technology, LLC is seeking a Quality Assurance Reviewer in Baltimore, MD to perform case, payment, and service quality reviews against established standards and document findings. This role supports corrective action and monthly reporting while ensuring adherence to policies and procedures.

The ideal candidate will have 3+ years in QA review or related analytical experience, with an Associate or Bachelor’s degree preferred.

Qualifications

• 3+ years in quality review, audit support, file review, claims review, eligibility review or similar analytical operational experience.
• Associate or bachelor’s degree preferred.
• Experience with public programs, compliance checks, or policy adherence is a plus.

Responsibilities

• Review customer, provider, case, and payment records against QA criteria and control standards.
• Document defects, observations, trends, and required follow-up actions clearly.
• Support pre-authorization reviews where required.
• Track repeat findings and assist with monthly reporting and evidence preparation.
• Escalate integrity issues, policy deviations, or systemic problems.
• Assist operations leaders and trainers by identifying error patterns and training needs.

Skills

Quality review

Audit support

Data analysis

Operational quality control

Regulatory compliance

Education

Associate or Bachelor degree preferred

Tools

Scorecards

Review forms

Audit tools

Job description

Fusion Advanced Technology, LLC is seeking a Quality Assurance Reviewer in Baltimore, MD to perform case, payment, and service quality reviews against established standards and document findings. This role supports corrective action and monthly reporting while ensuring adherence to policies and procedures.

The ideal candidate will have 3+ years in QA review or related analytical experience, with an Associate or Bachelor’s degree preferred.