Quality Assurance Specialist

POSITION SUMMARY

The Quality Assurance Specialist ensures that services offered to clients from both internal staff and external providers meet the requirements for reimbursement through the Medical Assistance Program. This position confirms that the cost of services and the billing for services are in line with county financial auditing practices, and that the documentation in the client record is complete, accurate, and organized in a manner that will withstand a review by state fiscal and program auditors.

QUALIFICATIONS

• Implements investigative skills to ensure compliance with program requirements; conducts evaluations and assessments of internal and external providers to determine if services align with the current the Medical Assistance Program standards; reviews client and contract files; performs consumer files reviews; examines document completion and compliance; collaborates with managers, supervisors, and staff to ensure that regulations are followed; reports findings; prepares recommendations for approval, as needed.
• Coordinates and monitors the maintenance of reporting and recording systems to ensure that accurate records are kept in accordance with legally mandated record management practices and procedures; maintains case records and reports; upholds basic records and routine supportive paperwork.
• Complies data and documentation to provide accurate and understandable reports; organizes and disseminates documents, reports, and letters.
• Assists leadership in program recertification preparation; reviews program recertification requirements; obtains necessary documentation; researches the recertification process.
• Applies motivational leadership to assist in staff supervision and participate in training and record-keeping for advisory committees.
• Establishes and maintains effective working relationships with internal and external partners; serves as liaison to community agencies to coordinate or ensure compliance with contracted service providers.
• Performs other related duties as required or assigned.

TRAINING AND PROFESSIONAL EXEPERIENCE QUALIFICATIONS

• Associate degree in human services, education, business management, or related field.
• One (1) year of experience working in the human services field.

DESIRED TRAINING AND PROFESSIONAL EXERIENCE QUALIFICATIONS

• Direct experience performing quality assurance roles within human services programs.
• Professional experience in a County Human Service agency.