QUALITY CONTROL CASE REVIEWER

City of New York • New York, NY

5d • $61,656 - $70,904

About The Position

The Department of Social Services (DSS), comprising the New York City Human Resources Administration and Department of Homeless Services, works to provide essential benefits, address poverty and income inequality, and prevent and address homelessness. The DSS Accountability Office protects the integrity of DSS-administered social services programs and ensures compliance with statutory, regulatory, and contractual standards.

Within the Office of Quality Assurance & Fiscal Integrity, the Medicaid Quality Control Unit conducts complex internal audits and quality control reviews, analyzes error trends, and identifies needs for corrective action plans or training. It also monitors Medicaid programs’ ongoing compliance with state and federal regulations. The Quality Control Case Reviewer conducts monthly reviews of Medical Assistance Program MICSA and Home Care Services Program cases, supports sample accuracy and audit preparation, reviews policies and procedures, and prepares summaries and records related to audit findings.

Applicants must hold permanent status in the Principal Administrative Associate civil service title. The position is listed as Principal Administrative Associate II. The scheduled hours are 9:00 a.m. to 5:00 p.m.

Requirements

• Applicants must be permanent in the Principal Administrative Associate civil service title.
• Meet one of the stated qualification pathways: a bachelor's degree plus two years of satisfactory full-time progressively responsible clerical/administrative experience, including one year in an administrative capacity or supervising clerical/administrative staff performing work of more than moderate difficulty; an associate degree or 60 semester credits plus three years of such experience, including one year of the specified administrative or supervisory experience; a high school diploma or equivalent plus four years of such experience, including one year of the specified administrative or supervisory experience; or equivalent education and/or experience, with the required one year of administrative or supervisory experience.
• Education above high school may substitute for general clerical/administrative experience at 30 college semester credits for six months of experience, up to a maximum of three years; it cannot substitute for the required year of administrative or supervisory experience.

Responsibilities

• Conduct monthly reviews of Medical Assistance Program MICSA and Home Care Services Program cases selected from samples of activated, recertified, denied, and closed transactions.
• Retrieve client information from HRA Viewer, Workspace Archival and Retrieval Manager (WARM), Electronic Medicaid New York (eMedNY), Systematic Alien Verification for Entitlements (SAVE), and State On-Line Query (SOLQ) databases.
• Conduct preliminary WMS inquiries and case reviews to verify the accuracy and auditability of review samples, and identify inconsistencies that may require sample-selection revisions.
• Collect policies and procedures required for audit reviews and share them with the Quality Control Case Review Supervisor to confirm their appropriateness.
• Review Medicaid procedures, journals, and desk aids to determine whether supervisory clarification is needed.
• Identify possible contradictions between state policies and agency procedures and report findings to the Quality Control Case Review Supervisor.
• Prepare case review summaries of audit findings for case error analyses.
• Prepare case records requested by external auditors and identify missing documentation and processing errors that could result in negative audit findings.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level