Quality Assurance Analyst

Wake County, NC - USA

Monthly Salary: $ 24 - 28

Posted on: 11 hours ago

Vacancies: 1 Vacancy

Job Summary

Agency

Division

HEALTH BENEFITS

Job Classification Title

Program Coordinator II (S)

Position Number

Grade

NC10

About Us

North Carolina State Government is one of the states largest employers with over 76000 employees all working toward a common goal: a safer and stronger North Carolina. We are a large organization comprised of various agencies offices and universities each providing important public services.

Eligible state employees are entitled to comprehensive benefits including a variety of leave options professional development opportunities insurance and more. To learn more about the benefits of being a North Carolina state employee visit the N.C. Office of State Human Resources website.

Permanent temporary and time-limited state government jobs can be found from the mountains to the coast. Find your next opportunity today!

Description of Work

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 .
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.

Knowledge Skills and Abilities/Management Preferences

Job Specific 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

Hourly Rate: $24.00 to $28.00

(Based on education and/or years of relevant work experience reflected on the application)

Candidates now meet the minimum qualifications of a position if they have the minimum education and experience listed on the vacancy announcement. The Knowledge Skills and Abilities l Management Preferences are not required. Applicants who possess the following skills are preferred:

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

This posting will close at 11:59 pm the night before the posting end date.

About the NC Division of Health Benefits:
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 and other programs that provide access to services and support for parents children seniors people with intellectual / developmental disabilities and behavioral health substance use and traumatic brain injury disorders. With a budget of over $27 billion in state and federal funds per fiscal year DHB ensures that more than 108000 enrolled providers are reimbursed for delivering covered services to 3.1 million beneficiaries.

Minimum Education and Experience

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 the Education and Experience Equivalency Guide for details.

Bachelors degree from appropriately accredited institution and one year of experience related to the area of assignment; or an equivalent combination of training and experience.

EEO Statement

The State of North Carolina is an Equal Employment Opportunity Employer and dedicated to providing employees with a work environment free from all forms of unlawful employment discrimination harassment or retaliation. The state provides reasonable accommodation to employees and applicants with disabilities; known limitations related to pregnancy childbirth or related medical conditions; and for religious beliefs observances and practices.

Recruiter:

Yalanda Fullwood

Recruiter Email:

Required Experience:

AgencyDivisionHEALTH BENEFITSJob Classification TitleProgram Coordinator II (S)Position NumberGradeNC10About UsNorth Carolina State Government is one of the states largest employers with over 76000 employees all working toward a common goal: a safer and stronger North Carolina. We are a large organi...