Quality Control - Coordinator 2

Job Summary

Program Integrity

Job Description

Reviews, analyzes, and investigates assigned Medicaid and CHIP eligibility cases to determine their validity and accuracy based on policy, procedure, and information found within the various Medicaid systems.

Completes special eligibility quality control research projects as assigned by LDH.

Ensures audit documentation is maintained and distributed appropriately.

Emails the appropriate sections when corrective action is required on a case review and log findings. Incumbent may also be required to follow up with different types of third party institutions as part of the audit process to validate information or follow-up on information that is unclear or incomplete and prepare in-depth written case review analyses and reports.

Assists the Department in establishing training needs for staff in an effort to reduce errors and increase the quality of Medicaid certifications.

Reviews changes to Medicaid policy and procedures and attend meetings with Medicaid staff.

Serves as backup to other Quality Control employees.

Works with LDH in identifying reporting / statistical needs in relation to Medicaid eligibility quality control review of cases.

Gathers quantifiable information from cases completed and compile statistical data on the Medicaid Eligibility Quality Control and PERM reviews performed by the unit.

Assembles charts and diagrams with the statistical information and provide visual charts to depict results of case reviews of special projects and pilots as assigned.

Assists with the development of the systems and applications utilized by the department to capture the necessary information electronically to be used for statistical computations.

Assists Coordinator 3 (C3) with ensuring MEQC unit meets all requirements for audit duties assigned by LDH relative to applicable Federal Medicaid Integrity Programs, including Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC).

Completes secondary review requests, and update the review findings along with any changes that result from the secondary reviews.

Completes special eligibility quality control research projects as assigned by LDH, and maintain the team's special QC project files.

Assists the Department in establishing training needs for staff with the objective of reducing errors and increasing the quality of Medicaid certifications.

Assists the C3 in creating pilot report forms and identifying reporting / statistical needs in relation to the Medicaid Eligibility Quality Control review of cases.

Assists the C3 in assembling charts and diagrams with the statistical information and provide visual charts to depict results of case reviews of special projects and pilots as assigned.

Ensures that QC staff are meeting expected project deadlines and communicate with the unit supervisor regarding any project deadline issues that arise.

Assists the C3 in developing and maintaining the Medicaid Quality Control Manual, shared storage sites, pilot review forms and guides, and other QC departmental procedure instructions to ensure that they are organized and current.

Attends meetings with Medicaid staff and assist with researching and troubleshooting policy related issues that tie to case reviews. Assist supervisor with assessment of Program Integrity needs and attend meetings with Program Integrity staff.

Conducts an annual performance evaluation for each subordinate, setting future goals and strategies.

Conducts recruitment, selection, training, supervision, and professional development of assigned staff.

Serves as backup to the QC C3.

Other duties as assigned.

Qualifications

Required :

• Bachelor's degree, or Associate's degree plus 3 years of professional experience, or 6 years of professional work experience.
• Minimum 2 years of professional experience in health care field, Medicaid / CHIP eligibility or Medicaid program support.
• Minimum 1 year of experience of working with Medicaid Eligibility Quality Control or Program Integrity, or Medicaid policy / procedures.
• Excellent analytical skills, effective organizational and time management skills.
• Great attention to detail and follow up, and verbal / written communications skills.
• Intermediate Microsoft Excel Skills.

Desired :

Required Attachments

Please upload the following documents in the Resume / Cover Letter section.

Applications that do not include the required uploaded documents may not be considered.