POSITION SUMMARY:

This position will entail creation of a quality assurance plan for accurate processing of Medicaid claims in compliance with state Medicaid policies. Ensures compliance with quality assurance plan, including audits and second level reviews. Coordinates implementation of initial ISO certification program.

DUTIES AND RESPONSIBILITIES:

Includes, but are not limited to the following:

1. Implements QA program, establishes procedures, conducts tests, and performs audits to ensure compliance with requirements.

2. Provides quality assurance for all deliverables to ensure accuracy and completeness.

3. Adheres to defined QA processes.

4. Properly follows process and procedure to ensure the results meet established standards.

5. Guides and mentors staff on the use of defined QA process in day-to-day activities.

6. Assists staff in identifying or recognizing quality problems; documents process, problems, and improvements to process.

7. Other duties as assigned.

REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

KNOWLEDGE, SKILLS, AND ABILITIES:

1. Working knowledge of Medicaid claims processing, and Medicaid policies and procedures.

2. Manage and implement the quality management and quality improvement programs.

3. Responsible for the design and implementation of policies and procedures to ensure that quality standards are met during production.

4. Relies on extensive experience and judgment to plan and accomplish goals.

5. Ensures programs and services are implemented at the highest standards.

6. Responsible for monitoring and updating policies and procedures to include regulatory changes.

7. Leads and directs the work of others.

EDUCATION, EXPERIENCE, AND TRAINING:

1. Bachelor’s or Master’s degree from an accredited program.

2. A minimum of (5) years working experience with quality assurance programs and standards.

Physical Demands – The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear, stand, walk, sit, use hands/finger, handle or feel objects, and reach with hands and arms. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities are required including close vision, distance vision, depth perception, and the ability to adjust focus.

We recognize the value of diversity in our workforce, and encourage all qualified candidates to apply. We thank all candidates who choose to apply, however, only those selected for a further interview will be contacted.