quality assurance analyst

Provider Resources, LLC; Erie (Erie County); On-site; USD 60,000 - 85,000; Full time

Job summary

Provider Resources, LLC conducts QA reviews of IDRE case processing activities to ensure CMS compliance, PRI quality standards, and accuracy of determinations. The role supports continuous improvement by documenting findings and tracking corrective actions, delivering actionable feedback to staff.

The position involves generating QA reports on error rates and trends, aiding CMS audit preparation, and participating in calibration sessions to maintain consistency across the team.

Qualifications

• 1 to 4 years of QA or compliance review experience, healthcare or IDRE preferred.
• Knowledge of CMS IDRE requirements and No Surprises Act preferred.
• Strong analytical skills to identify patterns and root causes.
• Detail oriented with careful case-file review.
• Clear written communication of QA findings.
• Ability to deliver constructive feedback to staff.

Responsibilities

• Conduct QA reviews of IDRE case files including eligibility determinations and documentation.
• Apply CMS IDRE quality standards and PRI quality criteria.
• Document QA findings with issues, standards, and corrections.
• Track corrective actions for identified QA findings.
• Provide feedback to staff and supervisors on quality issues.
• Generate QA reports on error rates and trends.
• Support CMS audit preparation with QA documentation and evidence.
• Participate in calibration sessions for consistent QA.

Skills

Quality assurance

Healthcare knowledge

CMS IDRE

No Surprises Act

Analytical thinking

Attention to detail

Written communication

Feedback delivery

Job description

Job Description

Position summary

Conducts quality assurance reviews of IDRE case processing activities - reviewing case files, eligibility determinations, communications, and determinations for compliance with CMS requirements, accuracy, and PRI quality standards. Supports continuous improvement by documenting findings and tracking corrective actions.

Essential functions

• Conduct QA reviews of assigned IDRE case files - eligibility determinations, case documentation, and party communications
• Apply CMS IDRE quality standards and PRI quality criteria to assess case file accuracy and compliance
• Document QA findings clearly - identify the issue, the applicable standard, and the required correction
• Track corrective action completion for identified QA findings
• Provide feedback to operational staff and supervisors on identified quality issues
• Generate QA reports on error rates, finding categories, and trends
• Support CMS audit preparation - QA documentation and evidence compilation
• Participate in calibration sessions to ensure consistent QA application across the team

Minimum qualifications

• 1 to 4 years of quality assurance or compliance review experience - healthcare or IDRE preferred
• Knowledge of CMS IDRE requirements and No Surprises Act preferred
• Strong analytical skills - identifies patterns and root causes of errors
• Detail-oriented - reads case files carefully and applies standards consistently
• Clear written communication - QA findings must be specific, accurate, and actionable
• Ability to deliver feedback constructively to operational staff

This job description is not an employment contract and is subject to change. PRI is an equal opportunity employer.