Quality Assurance Reviewer – Economic Benefits

What You'll Be Doing

The purpose of the Adult Medicaid Quality Assurance (QA) Reviewer is to conduct compliance audits, communicate quality information and provide support to staff in Economic Services (ES) Programs. The QA Reviewer partners with Economic Services training staff, systems support staff, works with management, and supervisory staff to discuss findings and develop corrective action plans. The AMA Quality Assurance Reviewer reports to the Quality Assurance Supervisor. Primary job functions include:

• Planning and leading quality reviews of Adult Medicaid cases
• Keeping abreast of policy changes and communicating them as necessary to staff
• Assisting with answering policy questions, and communicating with state representatives on policy clarifications
• Gathering information, analyzing trends, and reporting information to management, supervisory staff and members of the staff development team
• Assisting with the development of policy review, newsletters, checklists, job aids, and other materials that help staff become more proficient
• Assisting with the preparation of materials for external monitoring
• Assisting with development, improvement and training, on quality assurance monitoring tools

NOTE: Wake County Health and Human Services employees are required to be in their current role for a minimum of one (1) year to be eligible to apply for another Health and Human Services position. Upon acceptance of employment you acknowledge that (i) you will rescind your application for any other positions within Wake County Health and Human Services, (ii) after accepting your position with Wake County Health and Human Services you must remain in your role for one (1) year before you are eligible to apply for another position within Wake County Health and Human Services, (iii) if you work in the Health Clinics and Public Health Division, influenza immunization is a condition of initial and continued employment, subject to compliance with federal law.

About Our Team

Wake County Health and Human Services (WCHHS) is the consolidation of programs and services that include social services, public health, job search assistance, child support, and transportation. Our mission, in partnership with the community, is to facilitate full access to high quality and effective health and human services for Wake County residents. In addition to our numerous standard programs, Wake County Health and Human Services (WCHHS) is engaged in a number of special initiatives that are impacting services and programs throughout our entire agency. Whether legislated down from the changing regulations on the Federal or State level or bubbling up from the entrepreneurial spirit of our staff, you can always look forward to Wake County Health and Human Services implementing new and exciting enhancements to our services and programs.

The Basics (Required Education and Experience)

• Bachelor's degree
• Two years of job-related experience
• Equivalent education and experience are accepted

Beyond the Basics (Preferred Education and Experience)

• Two years or more of recent experience processing and auditing Adult Medicaid cases in NC FAST
• 91% or higher quality review average scores
• Demonstrated experience coaching employees to provide error-free work
• Proficient with using technology including Donesafe System

 

How Will We Know You're 'The One'?

• Current and thorough knowledge of Adult Medicaid policies
• Experience processing and auditing Adult Medicaid cases
• Recent experience utilizing NC FAST for Adult Medicaid
• Excellent communication skills (verbal and written)
• The ability to problem-solve, use analytic thinking, to collect and analyze data, and conduct research
• Commitment to accountability and continuous improvement
• Proficiency in Microsoft Office including Word, Excel, and PowerPoint

About This Position

Employment Type: Regular Work Schedule: Mon - Friday 8:00 am - 5:00 pm