Medicaid Quality Assurance Assistant

Sheboygan County
Job Description
Department: Health and Human Services – Medicaid Quality Assurance Assistant
Salary Range: $17.00/hr. to $24.34/hr.
Status: Full time (40 hours/week)
Purpose and Summary:
The Medicaid Quality Assurance assistant reviews Medicaid related documents within the Behavioral Health Division of the Department of Health and Human Services (HHS) for the purposes of identifying 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 Assistant also helps to train Division staff and contract providers to avoid Administrative Code errors and incorrect billings.
Essential Duties:
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 staff to recognize and correct errors and ensure program compliance and accuracy.
Performs Quality Assurance reviews on cases and contract provider records for compliance with Federal, State, and department policies, procedures and Administrative Codes. Analyzes the results of reviews and works with department 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. Maintains regular and predictable attendance and maintains all necessary documentation  and evidence in compliance with audit and statutory requirements. 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. Participates in unit and department-wide meetings, discussions, training, and activities, demonstrating orientation toward professional competence and continuous quality improvement; makes recommendations for and assists with service improvement when warranted. Performs other duties as assigned.
Two years' experience with individuals with a range of mental health and/or substance abuse diagnoses. Experience with MH/AODA Administrative Codes preferred. Experience in Quality Assurance practice preferred. 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. Knowledge and understanding of federal laws, State statutes, and administrative rules which regulate the services provided. Ability to coordinate activities and functions that cross unit and departmental lines and involve other county and community agencies. Ability to establish and maintain effective working relationships with co-workers, superiors, community partners, and the public at large. Ability to relate to people and to communicate effectively in both written and oral formats. Ability to maintain confidentiality. Ability to exercise sound judgment in confrontational and stressful situations. Ability to follow instructions, to complete tasks, and to work closely with the supervisor and others.
Type of Position:
Contact Information

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