QA Analyst, Compliance

About The Company Gainwell Technologies is a leading provider of innovative healthcare IT solutions and services dedicated to improving healthcare delivery and outcomes. With a strong commitment to quality, compliance, and technological advancement, Gainwell partners with government agencies, healthcare providers, and payers to streamline operations, enhance data accuracy, and ensure regulatory adherence. The company fosters a collaborative and inclusive work environment that values professional growth, work flexibility, and continuous learning. Recognized for its industry expertise and customer-centric approach, Gainwell strives to make healthcare work better for everyone by leveraging cutting-edge technology and committed talent. About The Role The Quality Assurance Compliance Analyst at Gainwell is a vital role focused on maintaining and enhancing quality and compliance standards within healthcare operations, specifically supporting the Medi-Cal account. This remote position involves reviewing healthcare claims, operational processes, and data to identify discrepancies, trends, and areas for improvement. The analyst will conduct audits, analyze claims data, and document findings to ensure accuracy and adherence to regulatory requirements and organizational policies. Collaborating closely with claims, clinical, compliance, and operational teams, the analyst will support root-cause analysis and recommend corrective actions to optimize processes and ensure compliance. This role offers an excellent opportunity for professionals passionate about healthcare quality, compliance, and data analysis to contribute meaningfully to a mission-driven organization while enjoying the flexibility of remote work. Qualifications High school diploma or GED required; bachelor's degree or equivalent professional experience preferredThree or more years of experience in quality assurance, compliance, auditing, healthcare operations, claims, or related fieldsExperience with healthcare claims adjudication, validation, denials, appeals, billing, or similar processesKnowledge of healthcare quality issues, coding errors, and compliance standardsFamiliarity with Medicaid or Medi-Cal operations and regulatory requirements (preferred)Proficiency in data analysis, trend identification, root-cause analysis, and process improvement initiativesExperience maintaining audit documentation and trailsKnowledge of healthcare systems such as EDMS, NICE CXone, or MMIS (a plus)Strong analytical, organizational, problem-solving, and communication skillsAttention to detail and ability to work independently in a remote environment Responsibilities Conduct quality reviews and audits of healthcare claims and operational processes to evaluate accuracy, completeness, and compliance with policies and regulatory standardsAnalyze claims data to identify trends, anomalies, coding errors, and quality issuesReview claims, denials, appeals, provider enrollment, and related operational activities for data accuracy and compliance concernsDocument audit findings, maintain comprehensive audit trails, and communicate results to stakeholdersParticipate in root-cause analysis and develop recommendations for corrective actions and process improvementsSupport compliance reporting, internal and external audits, and quality improvement initiativesCollaborate with cross-functional teams to implement best practices and ensure adherence to regulatory requirementsMaintain and update quality documentation, audit reports, and related records Benefits Competitive salary range of $53,900 to $77,000 per year, commensurate with experience and locationFlexible work arrangements with primarily remote work and occasional in-office visits as neededComprehensive health benefits package including medical, dental, and vision coverage401(k) retirement plan with employer matching contributionsGenerous paid time off and vacation policiesEducational assistance and professional development programsAccess to leadership and technical training academies to enhance skills and career growth Equal Opportunity Gainwell Technologies is an Equal Opportunity Employer. We are committed to fostering an inclusive environment where all qualified applicants receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy and related medical conditions), age, sexual orientation, gender identity, protected veteran status, disability, or any other legally protected characteristic. We believe diversity and inclusion are fundamental to our success and are dedicated to providing equitable opportunities for all candidates and employees.