Quality Assurance Analyst in Erie, Pennsylvania at PROVIDER RESOURCES INC

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.