Quality Assurance Analyst

State of North Carolina

1d•Remote

About The Position

This position is responsible for evaluating detailed recipient eligibility determinations for Medicaid programs made by county department of social services. This position will research NC Medicaid policy to ensure accurate determinations and identify instances of misapplied policy. Requires a detailed focus on internal control processes to mitigate risk related to Medicaid eligibility. The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid and other programs that provide access to services and supports for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget over $27 billion in state and federal funds per fiscal year, DHB ensures that more than 108,000 enrolled providers are reimbursed for delivering covered services to 3.1 million beneficiaries.

Requirements

Bachelor's degree from appropriately accredited institution and one year of experience related to the area of assignment; or an equivalent combination of training and experience.

Nice To Haves

Demonstrated knowledge of Medicaid policy to research, evaluate and analyze eligibility determinations for all Medicaid programs.
Demonstrated knowledge of the state’s NCFAST eligibility system.
Experience interpreting Quality Assurance policies, procedures, laws, rules, and regulations governing Medicaid eligibility and claims processing.
Proven ability to research and verify information provided by Medicaid applicants and beneficiaries.
Compliance monitoring experience for overseeing and managing quality assurance testing on an organization's day-to-day activities to ensure that compliance procedures are working as intended to keep the organization fully compliant with all regulatory requirements.

Responsibilities

Evaluating detailed recipient eligibility determinations for Medicaid programs made by county department of social services.
Researching NC Medicaid policy to ensure accurate determinations and identify instances of misapplied policy.
Focusing on internal control processes to mitigate risk related to Medicaid eligibility.
Interpreting Quality Assurance policies, procedures, laws, rules, and regulations governing Medicaid eligibility and claims processing.
Researching and verifying information provided by Medicaid applicants and beneficiaries.
Compliance monitoring for overseeing and managing quality assurance testing on an organization's day-to-day activities to ensure that compliance procedures are working as intended to keep the organization fully compliant with all regulatory requirements.