MEDICAID QUALITY CONTROL CASE REVIEW SUPERVISOR

Medicaid Quality Control Case Review Supervisor

Applicants must be permanent in the Principal Administrative Associate Civil Service Title. The DSS Accountability Office (DSS-AO) is responsible for protecting the integrity of social services programs administered by the New York City Department of Social Services (DSS) and ensuring that DSS complies with all statutory, regulatory, and contractual standards. Within DSS-AO, resides an area called the Office of Quality Assurance & Fiscal Integrity, the Medicaid Quality Control Unit (MAQC). They conduct complex internal audits and quality control reviews to identify areas of programmatic deficiencies. The unit analyzes error trends and determines the need for corrective action plans and / or training. MAQC also ensures the Medicaid programs' continuous adherence to state and federal regulations. State and Federal error rates are based on Medicaid policies and procedures perspectives with accurate and complete error findings. MAQC is recruiting for (1) one Principal Administrative Associate, who will function as a Medicaid Quality Control Case Review Supervisor who will :

• Review the audit findings determined by the Quality Control Case Reviewers to ensure they are relevant and appropriate. Review the programs' responses to error findings and determine whether MAQC agrees or disagrees with the justification provided.
• Ensure the Quality Control Case Reviewers validate the corrective actions taken by MICSA and HCSP staffs.
• Coordinate all activities in the Medicaid Quality Control unit. Schedule and assign work. Verify there are adequate case samples for audits and make recommendations for proper sampling practices.
• Conduct final review of completed assignments to ensure consistency in case error finding methodology.
• Train and update Quality Control staff on Medicaid eligibility policies and procedures. Provide targeted trainings based on the need of MAQC staff and program's audited.
• Ensure appropriate audit worksheets are created for each audit conducted. Verify they capture the elements necessary to assist the Quality Control Case Reviewers in their eligibility review findings.
• Assist the Medicaid Audit and Quality Control director with all external audit requests. Ensure documentation collected by the Quality Control Case Reviewers are complete and accurate.
• Compile data related to Medicaid eligibility determination errors for the Deputy Director to develop preliminary negative audit findings error rates.
• Chair staff meetings to review Medicaid monthly newsletters. Clarify State policies by interpreting them to convey the information to staff. Identify areas of discrepancy between state policies and MICSA procedures.
• Communicate the discrepancies to the Deputy Director.
• Provide Medicaid eligibility assistance when the Director responds to external negative audit findings.
• Prepare PowerPoint Medicaid training presentation for MICSA and HCSP supervisors by developing training modules in accordance with audit error findings and identified areas of deficiency.
• Conduct Medicaid eligibility training aimed at clarifying policies and procedures.

Work Schedule : Monday to Friday 9 am to 5 pm. Work Location : 4 World Trade Center PRINCIPAL ADMINISTRATIVE ASSOC - 10124

Qualifications :

1. A baccalaureate degree from an accredited college and three years of satisfactory full-time progressively responsible clerical / administrative experience, one year of which must have been in an administrative capacity or supervising staff performing clerical / administrative work of more than moderate difficulty; or 2. An associate degree or 60 semester credits from an accredited college and four years of satisfactory full-time progressively responsible clerical / administrative experience including one year of the administrative supervisory experience described in "1" above; or 3. A four-year high school diploma or its educational equivalent approved by a State's department of education or a recognized accrediting organization and five years of satisfactory full-time progressively responsible clerical / administrative experience including one year of the administrative supervisory experience as described in "1" above; 4. Education and / or experience equivalent to "1", "2", or "3" above. However, all candidates must possess the one year of administrative or supervisory experience as described in "1" above. Education above the high school level may be substituted for the general clerical / administrative experience (but not for the one year of administrative or supervisory experience described in "1" above) at a rate of 30 semester credits from an accredited college for 6 months of experience up to a maximum of 3 years.

Additional Information :

The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.