Quality Control Case Reviewer

YOU MUST BE PERMANENT IN THE PRINCIPAL ADMINISTRATIVE ASSOCIATE CIVIL SERVICE TITLE

The Department of Social Services Accountability Office (DSS-AO) is responsible for supporting the integrity of social services programs administered by the New York City Human Resources Administration (HRA), Department of Social Services (DSS) and Department of Homeless Services (DHS). Within DSS-AO, the Medicaid Quality Control Unit (MAQC) conducts 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 from Medicaid policies and procedures perspectives with accurate and complete error findings.

MAQC is recruiting for (1) one Principal Administrative Associate II to function as a Quality Control Case Reviewer, who will:

• Conduct the preliminary monthly review of MICSA and HCSP cases selected from a sample of activated, recertified, denied and closed transaction types. Retrieve client's information from the HRA Viewer, the Computer Output Laser Disk (COLD), the Electronic Medicaid New York (EMEDNY), the Systematic Alien Verification for Entitlement (SAVE) and from the State On-Line Query (SOLQ) databases.

• Ensure the accuracy of the review sample by conducting preliminary WMS inquiries and case review; utilize reports to verify that sample is auditable; identifies inconsistencies, when required, for sample selection revision. Collect all policies and procedures necessary for the audit review and share documents with the Quality Control Case Review Supervisor to ensure the appropriateness of the documents.

• Review Medicaid procedures, journals and desk aids to determine the need for supervisory clarification and identify possible contradictions between state policies and agency procedures. Report all findings to the Quality Control Case Review Supervisor.

• Prepare case review summaries related to audit findings to be used 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 by external auditors.

Work Location: 4 WTC NY NY

Hours/Schedule: 9AM -5PM

Minimum 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 3½ years.

Preferred Skills

• Possesses strong knowledge of Medicaid State policies and agency procedures.

• Possesses experience in auditing Medicaid cases and in identifying eligibility determination errors.

• Ability to effectively document and narrate Medicaid audit findings.

• Experience in responding to federal and state auditors and in justifying the agency's eligibility determination.

• Ability to interpret state Administrative Directives (ADM), General Information System (GIS) messages and Local District Memoranda (LDM).

• Proficient in the use of WMS, EmedNY, Medicaid Edits, CentraPort database, SOLQ, SAVE, Microsoft Word and Excel.

• Experience in supervising staff.

• Possesses analytical and Medicaid case review skills.

• Ability to make site visits to conduct MAP and HCSP staff ad hoc refresher training.

• Excellent communication skills.

55a Program

This position is also open to qualified persons with a disability who are eligible for the 55-a Program. Please indicate at the top of your resume and cover letter that you would like to be considered for the position through the 55-a Program.

Public Service Loan Forgiveness

As a prospective employee of the City of New York, you may be eligible for federal loan forgiveness programs and state repayment assistance programs. For more information, please visit the U.S. Department of Education's website at https://studentaid.gov/pslf/.

Residency Requirement

New York City residency is generally required within 90 days of appointment. However, City Employees in certain titles who have worked for the City for 2 continuous years may also be eligible to reside in Nassau, Suffolk, Putnam, Westchester, Rockland, or Orange County. To determine if the residency requirement applies to you, please discuss with the agency representative at the time of interview.

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.