NC Department of Health and Human Services · 5 hours ago
Quality Assurance Analyst
Wake County, NC
Full-time
Onsite
Entry Level
$24/hr - $28/hr
1+ years expThe NC Department of Health and Human Services is one of the largest employers in North Carolina, dedicated to improving public health and well-being. The Quality Assurance Analyst will be responsible for conducting reviews of Medicaid recipient eligibility determinations to ensure compliance with policy and accuracy, while also providing training and support to county staff.
Health Care
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 Department of Health and Human Services
The Department of Health and Human Services manages the delivery of health- and human-related services for all North Carolinians.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Erin Matteson
Chief Financial Officer, Opportunity and Well-being
Jean M. Sandaire
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