Quality Assurance Analyst – Prior Authorization
IVX Health
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $26 - $30 per hour
About the role
- Conduct structured audits of Intake and Prior Authorization cases
- Evaluate documentation accuracy, medical necessity support, and adherence to internal SOPs and payer policies
- Maintain defensible audit documentation and compliance standards
- Monitor SLA performance, denial trends, and recurring workflow errors
- Develop recurring QA reports with actionable insights
- Identify systemic process vulnerabilities and training gaps
- Document findings clearly and administer QA result notifications
- Partner with Operations leadership on corrective action plans
- Recommend workflow and SOP updates based on audit findings
- Support readiness for internal audits and compliance reviews
Requirements
- High School Diploma or GED required; Associate degree in a healthcare-related field (Medical Office Management, Medical Insurance, Medical Coding, or related) strongly preferred
- Minimum 3+ years of experience in prior authorization, benefits investigation, or revenue cycle operations
- Experience conducting documentation audits or quality assurance reviews in a healthcare environment
- Demonstrated knowledge of medical necessity review standards, prior authorization workflows, payer policies, and benefits investigation best practices
- Experience utilizing Excel for data tracking and analysis, as well as audit management or reporting platforms required
- Strong analytical thinking, attention to detail, and organizational skills
- Clear written and verbal communication skills
- Working knowledge of HIPAA and healthcare compliance standards
- Experience with EHR, practice management, or revenue cycle systems
Benefits
- Comprehensive Healthcare – Medical, dental, and vision coverage, including prescription drug plans and telemedicine services.
- Flexible Savings Options – Choose from Health Savings Accounts (HSA) and Health Reimbursement Arrangements (HRA) to manage healthcare costs.
- Supplemental Protection – Accident, critical illness, and hospital indemnity plans to provide additional financial security.
- Dependent Care FSA – Pre-tax savings for eligible childcare and dependent care expenses.
- 401(k) Retirement Plan – Secure your future with a competitive company match.
- Disability Coverage – Voluntary short-term and long-term disability plans to protect your income.
- Fertility and Family Support – Resources and benefits designed to support fertility care and family planning.
- Life and AD&D Insurance – Financial protection for you and your loved ones.
- Counseling and Wellness Support – Free resources to support emotional, physical, and financial well-being.
- Education Assistance – Tuition reimbursement and certification support to help you grow in your career.
- Continuing Education – Access to a CEU library for ongoing professional development.
- Charitable Giving and Volunteer Program – Matched donations and paid volunteer time off to support causes you care about.
- Employee Referral Bonus – Earn rewards for helping us find top talent.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
documentation auditsquality assurance reviewsmedical necessity review standardsprior authorization workflowspayer policiesbenefits investigation best practicesdata trackingdata analysisaudit managementreporting
Soft Skills
analytical thinkingattention to detailorganizational skillsclear written communicationclear verbal communication
Certifications
High School DiplomaGEDAssociate degree in healthcare-related field