Quality Assurance Analyst - HRSN

Quality Assurance Analyst - HRSN --------------------------------------------------------------- Job Summary This position is responsible for providing timely and accurate quality assurance, administrative, and analytical support for CareOregon’s internal Rent Assistance team and the Health-Related Social Needs (HRSN) benefit. The role ensures that member benefit allocations and payments are accurate, timely, and compliant with applicable regulatory, contractual, and organizational requirements. This is a hybrid position with the expectation to come to the downtown Portland office 1x/week. We are looking for candidates located in Portland Metro. Estimated Hiring Range: $66,690.00 - $81,510.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Quality Assurance Conduct timely and accurate quality assurance reviews of member benefit allocations prior to payment, ensuring alignment with state and federal regulations and CareOregon policies. Review supporting documentation and system data to validate eligibility, benefit limits, accuracy of calculations, and appropriateness of payment amounts. Identify trends, patterns, and root causes of errors; proactively recommend corrective actions to improve quality, consistency, and productivity. Research claim, invoice, enrollment, and benefit processing issues to determine source, contributing factors, and appropriate resolution, escalating issues as needed. Collaborate with the Rent Assistance team to reduce rework by clarifying requirements, identifying gaps in documentation, and recommending process or workflow improvements. Develop, maintain, and distribute summary-level, quality assurance, and performance reports for leadership and the Oregon Health Authority (OHA). Analyze data and quality review results to identify improvement opportunities, compliance risks, and training needs. Track corrective actions and outcomes to assess effectiveness of improvement efforts over time. Support audits, inquiries, and data requests by preparing accurate documentation and responsive analyses. Support the development and delivery of training materials, job aids, and guidance to proactively address quality trends, common errors, and policy updates. Partner with management and cross-functional teams to ensure quality assurance reviews remain effective, relevant, and aligned with organizational needs. Participate in meetings and workgroups related to HRSN benefits, rent assistance operations, and quality improvement initiatives. Administrative Support Perform accurate and timely data entry and accounting-related support, including reviewing invoices, ledgers, rental statements, and utility bills to determine eligible reimbursement or payment amounts in accordance with benefit policies and procedures. Ensure all documentation is complete, properly stored, and accessible for reporting, audit, and compliance purposes. Utilize technology systems and databases effectively for documentation, quality tracking, reporting, and communication. Use standard Microsoft Office applications (Excel, Word, PowerPoint, Outlook), SharePoint, Workday, Unite Us, and other applicable systems to create and maintain documents, spreadsheets, charts, graphs, and reports. Independently manage special projects or ad hoc assignments as assigned, including process reviews, data clean-up efforts, and pilot initiatives. Organizational Responsibilities Perform work in alignment with the organization’s mission, vision and values. Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals. Strive to meet annual business goals in support of the organization’s strategic goals. Adhere to the organization’s policies, procedures and other relevant compliance needs. Perform other duties as needed. Experience and/or Education Required Minimum 2 years’ experience in data quality assurance to include data entry, tracking, and reporting Minimum 4 years’ experience in Medicaid, health plan operations, or managed care organizations Experience with regulation and applying rules to a process Preferred Experience in managed care Experience in quality assurance or improvement Experience collaborating on or managing projects Housing familiarity Knowledge, Skills and Abilities Required Knowledge Working knowledge of Microsoft Office system, including intermediate Excel skills Knowledge of basic medical terminology Knowledge of care management platforms and experience with documenting in care management or similar platform Knowledge and experience with Federal, State and Local regulations and HIPAA privacy rules and regulations Skills and Abilities Strong organizational skills Attention to detail Familiarity with Medicaid claims billing and coding Computer skills and ability to learn new technology quickly Ability to use good judgment, personal initiative and discretion to perform work with particular attention to detail Ability to effectively interact with individuals at all levels internal and external to the organization Good written and verbal communication skills Good customer service skills Basic teamwork skills Ability to manage multiple tasks Ability to work in a fast-paced environment Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home Schedule: Monday – Friday; 8:00am-5:00pm We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer.  The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.