Apply on Employer Site

NYC Department of Social Services · 2 weeks ago

MEDICAID QUALITY CONTROL CASE REVIEW SUPERVISOR

Manhattan, NY

Full-time

Onsite

Mid, Senior Level

4+ years exp

NYC Department of Social Services is responsible for protecting the integrity of social services programs. They are seeking a Medicaid Quality Control Case Review Supervisor to oversee audit findings, ensure compliance with Medicaid policies, and coordinate activities within the Quality Control unit.

ConsultingGovernmentNon ProfitSocial

No H1B

Responsibilities

Review the audit findings determined by the Quality Control Case Reviewers to ensure they are relevant and appropriate. Review the programs' responses to error findings and determine whether MAQC agrees or disagrees with the justification provided

Ensure the Quality Control Case Reviewers validate the corrective actions taken by MICSA and HCSP staffs

Coordinate all activities in the Medicaid Quality Control unit. Schedule and assign work. Verify there are adequate case samples for audits and make recommendation for proper sampling practices

Conduct final review of completed assignments to ensure consistency in case error finding methodology

Train and update Quality Control staff on Medicaid eligibility policies and procedures. Provide targeted trainings based on the need of MAQC staff and program’s audited

Ensure appropriate audit worksheets are created for each audit conducted. Verify they capture the elements necessary to assist the Quality Control Case Reviewers in their eligibility review findings

Assist the Medicaid Audit and Quality Control director with all external audit requests. Ensure documentation collected by the Quality Control Case Reviewers are complete and accurate

Compile data related to Medicaid eligibility determination errors for the Deputy Director to develop preliminary negative audit findings error rates

Chair staff meetings to review Medicaid monthly newsletters. Clarify State policies by interpreting them to convey the information to staff. Identify areas of discrepancy between state policies and MICSA procedures

Communicate the discrepancies to the Deputy Director

Provide Medicaid eligibility assistance when the Director responds to external negative audit findings

Prepare PowerPoint Medicaid training presentation for MICSA and HCSP supervisors by developing training modules in accordance with audit error findings and identified areas of deficiency

Conduct Medicaid eligibility training aimed at clarifying policies and procedures

Qualification

Medicaid eligibility policiesQuality control auditingSupervisory experienceData compilationTraining developmentTeam coordinationCommunication skillsProblem-solving

Required

A baccalaureate degree from an accredited college and three years of satisfactory full-time progressively responsible clerical/administrative experience, one year of which must have been in an administrative capacity or supervising staff performing clerical/administrative work of more than moderate difficulty

An associate degree or 60 semester credits from an accredited college and four years of satisfactory full-time progressively responsible clerical/administrative experience including one year of the administrative supervisory experience described in '1' above

A four-year high school diploma or its educational equivalent approved by a State's department of education or a recognized accrediting organization and five years of satisfactory full-time progressively responsible clerical/administrative experience including one year of the administrative supervisory experience as described in '1' above

Education and/or experience equivalent to '1', '2', or '3' above. However, all candidates must possess the one year of administrative or supervisory experience as described in '1' above

Education above the high school level may be substituted for the general clerical/administrative experience (but not for the one year of administrative or supervisory experience described in '1' above) at a rate of 30 semester credits from an accredited college for 6 months of experience up to a maximum of 3½ years

Company

NYC Department of Social Services

The Department of Social Services (DSS) is comprised of the administrative units of the NYC Human Resources Administration (HRA) and the Department of Homeless Services (DHS).

Founded in 1966

New York, New York, USA

10001+ employees