Medicaid Quality Assurance Specialist-Full Time
Print ()
Apply
Medicaid Quality Assurance Specialist-Full Time
Salary
$21.50 – $22.67 Hourly
Location
Appleton, WI
Job Type
Full-time
Department
DHHS Mental Health
Job Number
Typical Work Hours/Shift:
Monday – Friday 8:00 AM to 4:30 PM, with possibilities of overtime
- Description
- Benefits
- Questions
Position Purpose
The Medicaid Quality Assurance Specialist reviews Medicaid related services within the Mental Health/Alcohol and Other Drug Abuse (MH/AODA) Division of the Department of Health and Human Services (DHHS) for the purposes of identifying client, staff and systems errors that may result in improper billings to third parties, incorrect benefits to clients, and sometimes, fraudulent activities (intentional program violations by the client, provider, or staff member). The Medicaid Quality Assurance Specialist also helps us train Division staff and contract providers to avoid Administrative Code errors, incorrect billings, and to ensure general quality assurance.
The hours for this role are:
Monday – Friday 8:00 AM to 4:30 PM, with possibilities of overtime
Key Responsibilities
The following duties are most critical for this position. These are not to be construed as exclusive or all-inclusive. Other duties may be required and assigned.
- Maintains knowledge of Federal and State rules, regulations and Administrative Codes that impact Medicaid.Trains MH/AODA Division staff to recognize and correct errors and ensure program compliance and accuracy.
- Performs Quality Assurance reviews on Division cases and contract provider records for compliance with Federal, State, and Division policies, procedures and Administrative Codes.Analyzes the results of reviews and works with MH/AODA Division staff on assisting with implementing corrective measures.
- Develops and maintains resources, networks with outside agencies and attends necessary training in order to maintain current knowledge of all rules and regulations enacted by Federal, State and local entities for Medicaid.
- Identifies and assists in developing improvement strategies for all of the MH/AODA Division Medicaid programs and monitors results of implementation of those improvement strategies.Ensures that a continuous improvement process is maintained in the MH/AODA Division for all Medicaid programs.
- Maintains regular and predictable attendance and maintains all necessary documentation and evidence in compliance with audit and statutory requirements.
- Effectively facilitates meetings with leadership, management, and staff on the analysis of performance including:identification of challenges, achievement, and compliance with established guidelines and best practice standards.
- Participates actively and effectively in development activities such as conference calls, professional meetings to include MH/AODA and Fiscal related Statewide and Regional meetings.
- Completes and maintains necessary documentation and reports according to applicable requirements, Codes and policies.
Education/Certifications/Experience Requirements
- Bachelor’s degree in a human services related field.
- Two years’ experience in direct practice with individuals with a range of mental health and/or substance abuse diagnoses.
- Experience in MH/AODA service facilitation and MH/AODA Administrative Codes.
- Experience in Quality Assurance practice.
- Case Management experience.
Required or Preferred Skills
- Displays a high level of initiative, effort and commitment towards completing assignments efficiently and accurately.Works well in independent project development and adapts easily to multiple projects, assignments, and deadlines.
- Effective interpersonal skills, communication skills, and a flexible approach.
- Ability to attend staffings and other meetings as needed.
- Ability to maintain confidential information, including worker performance.
- Valid Wisconsin Driver’s License.
OUTAGAMIE COUNTY IS AN EQUAL OPPORTUNITY EMPLOYER. IN COMPLIANCE WITH THE AMERICANS WITH DISABILITIES ACT, THE COUNTY WILL PROVIDE REASONABLE ACCOMMODATIONS TO QUALIFIED INDIVIDUALS WITH DISABILITIES AND ENCOURAGES BOTH PROSPECTIVE EMPLOYEES AND INCUMBENTS TO DISCUSS POTENTIAL ACCOMMODATIONS WITH THE EMPLOYER.