Quality Assurance Analyst | Prior Authorization

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

IVX Health 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 within a growing healthcare organization.

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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
• Develop 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

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What We’re Looking For

• 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
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