Position Summary

The Analyst, Quality Assurance & Validation serves as the enterprise owner of contract-to-claim data integrity across the billing system of record and related specialty-pharmacy platforms. The role ensures that every payer fee schedule, reimbursement rule, and configuration is validated against approved Managed Markets contracts prior to activation—safeguarding realized revenue, payer confidence, and operational compliance. Operating at the intersection of Operations, Managed Markets, Finance, and IT, this position establishes the governance, testing, and performance frameworks that uphold system accuracy, mitigate audit risk, and deliver measurable revenue protection.

The QA Analyst functions as a financial safeguard, systematically identifying and correcting contractual risks that, if left unaddressed, could result in multimillion-dollar liabilities, penalties, or lost revenue. This role is critical to maximizing the return on investment for every contract by ensuring the organization captures the full value of its agreements while mitigating costly errors, disputes, and compliance exposures—driving sustainable, long-term profitability.

The Analyst serves as both a hands-on validator and a strategic control architect, embedding QA discipline across the payer-contract lifecycle.

Essential Functions and Duties

Leadership & Governance:

• Establish and lead the Quality Assurance & Validation framework for the billing system of record, ensuring payer-data accuracy and configuration integrity.
• Define validation standards, testing protocols, and approval workflows across Managed Markets and Operations.
• Define validation standards, testing protocols, and approval workflows across Managed Markets and Operations.
• Serve as primary liaison among Managed Markets, Operations, Finance, and IT on data-integrity and configuration-governance matters.
• Present variance analyses and QA-performance reports to leadership, recommending systemic corrective actions and process improvements.

Contract-to-System Validation:

• Reconcile billing-system fee schedules, DRI logic, and reimbursement algorithms against executed payer contracts.
• Validate payer methodologies (AWP, ASP, WAC, NADAC, LQAWP, hybrid) for accuracy and currency.
• Audit contract uploads for hierarchy accuracy and configuration completeness prior to go-live.
• Maintain traceability matrices linking each configuration to its originating contract clause.
• Maintain traceability matrices linking each configuration to its originating contract clause.
• Communicate setup requirements to Intake, Reauthorization, Pharmacy, and Reimbursement to ensure seamless downstream claim processing.

Operational & Financial Quality Assurance:

• Partner with Operations and Finance to monitor payer-level reimbursement accuracy and margin preservation.
• Conduct pre- and post-implementation audits to verify compliance with contractual and regulatory standards.
• Lead root-cause analyses of revenue variances or denials tied to configuration or data discrepancies.
• Maintain validation dashboards and provide executive QA reporting.

Cross-Functional Collaboration:

• Collaborate with Managed Markets on contract interpretation to ensure validation aligns with executed payer terms.
• Partner with IT and Database Administration to test configuration updates and enhancements in staging environments.
• Interface with Reimbursement and Intake teams to confirm claim accuracy and data continuity.
• Engage with Managed Markets for clarifications or change notifications—without altering, negotiating, or uploading contract terms.
• Identify and implement automation opportunities within the billing system or related workflows.

Process Improvement & Automation:

• Develop standardized QA documentation templates, audit checklists, and validation-trail tools.
• Identify and implement automation opportunities within the billing system or related workflows.
• Recommend system enhancements to improve visibility, data quality, and control efficiency.

General Responsibilities:

• Adheres specifically to all company policies and procedures, Federal and State regulations, and laws.

• Display dedication to position responsibilities and achieve assigned goals and objectives.

• Always represent the Company in a professional manner and appearance.
• Understand and internalize the Company’s purpose.
• Display loyalty to the Company and its organizational values.
• Display enthusiasm and dedication to learning how to be more effective on the job and share knowledge with others.
• Work effectively with co-workers, internal and external customers and others by sharing ideas in a constructive and positive manner; listen to and objectively consider ideas and suggestions from others; keep commitments; keep others informed of work progress, timetables, and issues; address problems and issues constructively to find mutually acceptable and practical business solutions; address others by name, title, or other respectful identifier, and respect the diversity of our work force in actions, words, and deeds.

• Comply with the policies and procedures stated in the Injury and Illness Prevention Program by always working in a safe manner and immediately reporting any injury, safety hazard, or program violation.

• Ensure conduct is consistent with all Compliance Program Policies and procedures when engaging in any activity on behalf of the company. Immediately report any concerns or violations.

• Other duties as assigned.

Education, Knowledge, Skills, and Experience

Required Education:

• Bachelor’s degree in Business, Data Analytics, Finance, Healthcare Administration, or related field.
• In lieu of degree, a minimum of three(3) to five (5) equivalent professional experience (≥ 5 years) in quality assurance, operations, or systems validation may substitute.

Required Knowledge:

• Familiarity with of payer contracts, reimbursement methodologies, and specialty-pharmacy billing logic.
• Strong understanding of QA principles, variance analysis, and data-integrity auditing.

Preferred Knowledge:

• Working knowledge of MedForce, ConvergePoint, and AlayaCare systems.
• Understanding of healthcare compliance frameworks (HIPAA, HITECH, URAC).
• Familiarity with CPR+, Excel (advanced), and report generation.

Required Experience:

• Minimum three(3) years in contract QA, reimbursement analytics, or system validation.
• Demonstrated record of improving data accuracy or reducing claim rework.
  Experience leading cross-departmental quality initiatives.

Preferred Experience:

• Prior exposure to enterprise-level QA governance or system migration projects.
• Experience designing KPIs and dashboards for revenue-assurance reporting.

Required Skills:

• Advanced Excel and analytical modeling skills.
• Exceptional attention to detail and process discipline.
• Strong executive-level communication and documentation ability.
• Ability to lead QA reviews and influence without direct authority.

Preferred Skills:

• SQL, Power BI, or Tableau for data validation and visualization.
• Experience training others in QA procedures and audit preparation.

Physical requirements

Vision, hearing, speech, movements requiring the use of wrists, hands and/or fingers. Must have the ability to view a computer screen for prolonged periods and the ability to sit for extended periods. Must have the ability to work the hours and days required to complete the essential functions of the position, as scheduled. Must have the ability to lift and maneuver items of at least 20 lbs. Must have the ability to travel occasionally. Working condition include normal office setting.

Mental Demands

Learning, thinking, concentration and the ability to work under pressure, particularly during busy times. Must be able to pay close attention to detail and be able to work as a member of a team to ensure excellent customer service. Must have the ability to interact effectively with co-workers and customers, and exercise self-control and diplomacy in customer and employee relations’ situations. Must have the ability to exercise discretion as well as appropriate judgments when necessary. Must be proactive in finding solutions.

Direct Reports

No

EEO Statement

FFF Enterprises and Nufactor are an equal opportunity employer and prohibits discrimination and harassment based on the following characteristics: race, color, religion, national origin, physical or mental disability, gender, age (40 years and over) qualified veteran and any other characteristic protected by state or federal anti-discrimination law covering employment. These categories are defined according to Government Code section 12920. The Company prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has or is perceived as having any of those characteristics.

Acknowledgement

The above statements are intended to describe the general nature and level of work being performed by the incumbent assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and/or skills required of all personnel so classified.

The undersigned employee acknowledges receipt of the Job Description for the employee’s position and understands the essential functions, responsibilities, and qualifications of the position. Furthermore, the employee acknowledges that this Job Description does not include all the essential functions of this position, and that these essential functions may change as deemed necessary by the manager.