NC Office of State Human Resources · 12 hours ago
Quality Assurance Analyst
Wake County, NC
Full-time
Hybrid
Entry Level
$24/hr - $28/hr
1+ years expThe NC Office of State Human Resources is seeking a Quality Assurance Analyst to ensure the accuracy of Medicaid recipient eligibility determinations. The role involves conducting reviews, collaborating with county staff, and preparing reports to improve compliance with Medicaid policies.
Government Administration
No H1B
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
Qualification
Required
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
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
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
Benefits
Comprehensive benefits
A variety of leave options
Professional development opportunities
Insurance
Health insurance coverage under the High-Deductible Health Plan (HDHP)
Company
NC Office of State Human Resources
Find a job with one of the state's largest employers, where career opportunities are wide-ranging, and every job helps enhance the quality of life for NC citizens! The Office of State Human Resources (OSHR) serves as the "Center of Human Resources Expertise" for the State of North Carolina through an integrated, multidisciplinary, professional Human Resources Team that is collaborative, strategic, and customer-focused, and supports state government efforts to attract, retain, develop, and motivate a high-performing, diverse workforce.
10001+ employees
Funding
Current Stage
Late StageCompany data provided by crunchbase