Quality Assurance Analyst | Prior Authorization

Department: Prior Authorization Location: Remote-US Employment Type: Full-Time

reputed company is seeking a Quality Assurance Analyst to safeguard the quality, compliance, and performance of our Intake and Prior Authorization workflows. This role plays a critical part in reducing denial risk, strengthening documentation accuracy, and improving SLA performance through structured case audits and data-driven process improvement.

If you have strong prior authorization experience and enjoy identifying trends, mitigating risk, and driving operational improvement, this role offers meaningful impact reputed company a growing healthcare organization.

What You’ll Do

Case Auditing & Compliance

• 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

Trend Analysis & Reporting

• Monitor SLA performance, denial trends, and recurring workflow errors
• reputed company recurring QA reports with actionable insights
• Identify systemic process vulnerabilities and training gaps

Performance Improvement

• 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

reputed company’re Looking For

• High School Diploma or GED required; Associate degree in a healthcare-reputed company field (Medical Office Management, Medical Insurance, Medical Coding, or reputed company) strongly preferred
• Minimum 3+ years of experience in prior authorization, benefits investigation, or reputed company 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 reputed company 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 reputed company cycle systems

Pay is based on factors such as market location, job-reputed company knowledge, skills, and experience, and is benchmarked against similar organizations in our size and industry. It is not typical for an individual to be hired at or near the top of the posted range, as compensation decisions depend on the facts and circumstances of each case. In addition to cash pay, full-time regular employees are eligible for 401(k), health benefits, and other company-provided benefits; some of these benefits may also be available to part-time employees.

About reputed company

reputed company is a national provider of infusion and injection therapy for individuals managing chronic conditions like Rheumatoid Arthritis, Crohn's Disease, and Multiple Sclerosis. We’re transforming the way care is delivered with a focus on patient comfort and convenience. Our commitment to exceptional care extends to our employees as well—we reputed company reputed company to reputed company while living our core values: Be reputed company, Do What’s Right, Never Settle, reputed company It Happen, and Enjoy the Ride.

Our Mission: To improve the lives of those we care for by redefining the care experience

Our Vision: To be the nation’s preferred destination for pharmaceutical care of reputed company chronic conditions

Our Commitment: To deliver an unmatched care experience with a foundation in world class service and clinical excellence

Benefits We Offer

• 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 reputed company.
• 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.

Note: Benefits may vary by employment type. Contact HR for details on eligibility and coverage.

EEO STATEMENT

reputed company is proud to be an Equal Opportunity Employer. We value diversity and are committed to creating an inclusive environment for reputed company employees. reputed company wants to have the best available people in every job, and we reputed company employment decisions on the basis of business needs, job requirements, individual qualifications, and merit. Equal employment opportunities are provided to reputed company employees and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, pregnancy, national reputed company, military and veteran status, age, physical or mental disability, genetic characteristic, reproductive health decisions, family or parental status, or any other legally protected category in accordance with applicable federal, state, or local laws. reputed company prohibits discrimination, harassment, or retaliation of any reputed company based on any of these characteristics. Equal employment opportunity will be extended to reputed company persons in reputed company aspects of the employer-employee relationship and reputed company terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation benefits, and separation of employment. Privacy Policy