New Job Quality Assurance Analyst In North Carolina
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| Quality Assurance Analyst |
Quality Assurance Analyst
Company : North Carolina Dept of Health and Human Services
Salary : $40,442 - $70,774 a year
Location : North Carolina
Full Description
Description of Work
**This position is exempt from the State Human Resources Act**
This posting is for a pending vacancy, anticipated 08/01/2023.
TELEWORK AVAILABILITY: We trust our employees to be self-motivated and successful in hybrid/remote roles; NC Department of Health and Human Services offers work from home options and variable work schedule flexibility for this position.
This position is home-based. This position is expected to travel to Western North Carolina counties to conduct site visits and meetings. Depending on business needs, this position may require overnight travel 3 to 5 nights per month. This position will also be expected to attend meetings in Raleigh, North Carolina on a monthly or quarterly basis.
Position Summary
The DHB Office of Compliance and Program Integrity (OCPI) is responsible for the strategic planning and tactical execution of compliance reviews and audits to ensure compliance with all state and federal rules and regulations, procedures and principles governing Medicaid programs and operations. The Quality Assurance Analyst, classified as a Program Coordinator II, reports to the Associate Director of Member Compliance. This position conducts reviews of recipient eligibility determinations in local Department of Social Services (DSS) in an assigned geographical area to ensure that determinations for Medicaid programs are made accurately and in compliance with state policy while identifying instances of errors for resolution.
Job Specific Responsibilities
- Conduct reviews of recipient eligibility determinations in local Department of Social Services in an assigned geographical area to ensure that determinations for Medicaid programs are made accurately and in compliance with policy while identifying instances of error for resolutions.
- Conduct onsite targeted reviews of eligibility determinations in county departments of social services.
- Conduct conferences with county department of social services for purposes of explaining error findings and initiating corrective action activities.
- Prepare written reports on errors for counties, present training to counties on QC findings and activities, and respond to questions from counties regarding errors.
Applicants are encouraged to apply for positions of interest, regardless of their current grade level and job classification. A pay increase may or may not result. Salary decisions are based on relevant education and experience, budget, and internal equity.
About NC Medicaid (Division of Health Benefits)
The North Carolina Department of Health and Human Services (NCDHHS) works closely with beneficiaries, health care professionals, community leaders and advocacy groups; local, state and federal entities; and other community partners vested to improve the health and safety of all North Carolinians by providing essential human services. NCDHHS is one of the largest, most complex agencies in the state, with about 17,000 employees.
The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid, NC Medicaid Managed Care and other programs that provide access to services and supports for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget over $21 billion in state and federal funds per fiscal year, DHB ensures that more than 96,000 enrolled providers are reimbursed for delivering covered services to 2.9 million beneficiaries.
Realizing the strength of DHB lies in its employees, DHB remains dedicated in its efforts to create and maintain a diverse, equitable and inclusive workplace environment.
Knowledge, Skills and Abilities / Competencies
To receive credit for all of your work history and credentials, you must list the information on the application form. Any information listed under the text resume section or on an attachment will not be considered for qualifying credit. Qualified applicants must document on the application that they possess all of the following:
- Proven ability in establishing and maintaining effective working relationships.
- Excellent oral and written communication skills.
- Proficiency in Microsoft Office programs such as Excel, Outlook, PowerPoint, and Word.
- Thorough knowledge and ability to interpret Quality Assurance (QA) policies and procedures, and laws, rules and regulations governing claims processing and eligibility in Medicaid programs.
- Ability to evaluate and analyze cases for Medicaid programs, requiring problem-solving and critical thinking skills.
- At least three years of experience working with NCFAST and NCTracks.
- At least three years of experience keying and determining eligibility for a Medicaid applicant or beneficiary and researching and verifying information provided by a Medicaid applicant or beneficiary.
Management Preferences:
- Previous and proven work experience at Division of Health Benefits/NC Medicaid.
- Familiarity with relevant and current NC Medicaid operations.
- Previous work experience as an eligibility caseworker or investigator.
- Experience conducting second level reviews of Medicaid eligibility.
- Experience developing and/or conducting training on social services programs.
- Knowledge of internal control processes to reduce and/or eliminate risks in Medicaid programs.
Minimum Education and Experience Requirements
Some state job postings say you can qualify by an “equivalent combination of education and experience.” If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both. See
oshr.nc.gov/experience-guide
for details.
Bachelor’s degree from appropriately accredited institution and one year of experience related to the area of assignment; or an equivalent combination of training and experience.
Degrees must be from appropriately accredited colleges or universities.
Supplemental and Contact Information
The North Carolina Department of Health and Human Services is an Equal Opportunity Employer.
Pre-employment criminal background checks are required for all positions with the Division of Health Benefits (DHB).
To be under consideration for this vacancy, all applicants must complete an online application using this link: https://www.governmentjobs.com/careers/northcarolina. If multiple applications are submitted to an individual posting, only the most recent application received prior to the posting close date will be evaluated for consideration.
Due to the volume of applications received, we are unable to provide information regarding the status of your application over the phone. To check the status of your application, please log in to your account. You will either receive a call to schedule an interview or an email notifying you when the job has been filled.
For technical issues with your application, please call the NeoGov Help Line at 855-524-5627. Applicants will be communicated with via email only for updates on the status of their application. If there are any questions about this posting other than your application status, please contact us at [email protected].