Quality Assurance Analyst

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.