QUALITY CONTROL CASE REVIEWER
Core
Conduct monthly quality control reviews of Medicaid Medical Assistance Program (MAP) and Home Care Services Program (HCSP) cases to ensure program integrity and compliance with state/federal regulations.
Role type
Principal Administrative Associate II (Quality Control Case Reviewer)
Builds
Medicaid program compliance and audit readiness
Domain
Public sector social services / Medicaid administration
Deliverable
dashboards & analysis
Required skills
Case review, data retrieval from multiple databases, policy interpretation, error analysis, report preparation, documentation management
Preferred skills
None stated
Technologies
HRA Viewer, Workspace Archival and Retrieval Manager (WARM), Electronic Medicaid New York (eMedNY), Systematic Alien Verification for Entitlements (SAVE), State On-Line Query (SOLQ)
Responsibilities
Review selected MAP and HCSP cases for accuracy and compliance; Retrieve client information from various databases; Verify audit sample integrity; Collect and validate audit policies and procedures; Identify contradictions between state policies and agency procedures; Prepare case review summaries and records for external auditors
Seniority
Mid-level, supervisory experience required