Quality Assurance Analyst

State of North Carolina

19h • $24 - $28

About The Position

This is a temporary position and there are no leave or retirement benefits offered with this position. Temporary employees who work an annual average of 30 or more hours per week may be eligible for health insurance coverage under the High-Deductible Health Plan (HDHP). For more information on health benefits offered visit www.shpnc.org. NOTE: Permanent and time-limited NC State Government employees must separate from their permanent or time-limited position to work in a temporary position. Temporary Solutions cannot accommodate dual employment. This position is responsible for conducting reviews of Medicaid recipient eligibility determinations in local Departments of Social Services. The purpose is to ensure determinations made for Medicaid programs are accurate and in compliance with policy while identifying instances of error for resolutions. This position conducts conferences with county directors and staff for the purpose of explaining review findings and initiating corrective action activities as needed. Additionally, this position is responsible for preparing written reports on review findings for counties, presenting training to counties on internal control activities to mitigate risk, and responding to questions from counties regarding case reviews.

Requirements

• 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.

Nice To Haves

• Prior experience as an eligibility caseworker or investigator
• Ability to interpret and apply rules, regulations, standards, and policies regarding Medicaid eligibility
• Extensive knowledge of NCFAST eligibility system and NC TRACKS (MMIS) system
• Experience with conducting reviews of Medicaid eligibility

Responsibilities

• Conduct statewide reviews of Medicaid cases for accuracy and timeliness of eligibility determinations
• Perform statewide reviews of Medicaid cases for application of eligibility policies and procedures in the approval, denial, and termination of benefits
• Following State policy regulations for quality control reviews, systematically review and evaluate samples of cases, and accurately document review findings
• Collaborate with county staff on a monthly basis to report case review findings
• Provide support to county staff in implementing internal control procedures to mitigate error risk and recurrence
• Analyze Medicaid policy to enhance knowledge needed to conduct accurate case reviews

Benefits

• Eligible state employees are entitled to comprehensive benefits, including a variety of leave options, professional development opportunities, insurance, and more.

What This Job Offers

• Career Level: Mid Level