Program Integrity - Quality Assurance Reviewer

J  o  b    D  e  s  c  r  i  p  t  i  o  n

Job Information

Title:

Program Integrity - Quality Assurance Reviewer

Market Range:

MR17

Approved Date:

9/9/2022 4:09:54 PM

FLSA:

Non-Exempt

EEO Code:

PROFESSIONALS

Career Level:

P2

Career Level Description:

Professional Level 2

Job Code:

100943

Job Family:

Social Services

Sub Family:

CQI, Training and Development

Primary Purpose

Conducts quality assurance reviews within the Program Integrity Unit to assure program standards are maintained, as it relates to the prevention, detection, prosecution and enforcement of over issuance, overpayment and fraud in Economic Benefit Programs.  Consults with management to address and resolve findings based on data analysis for program integrity trends. Provides Program Integrity policy and technical training. 

•

Conducts qualitative review audits on referrals completed by Department Program Auditors for established and unsubstantiated claims of fraud, misuse, and abuse including the disqualification process for all ESS benefit programs to include FNS, Medicaid, Child Care Subsidy, Energy, Housing and Special Assistance.  Implements plans to ensure that a random sampling of cases are reviewed. Provides coaching and training as needed to address the identified needs highlighted during the CQI process.

1

60%

•

Develops effective curriculum, training materials, and job aids in the delivery of in-person and eLearning training for new and existing Program Integrity staff. Ensures training in each benefit assistance program is aligned with Program Integrity for Federal and State policies. Acts as a consultant to Department Program Auditors and agency staff to provide interpretation of program-related federal, state, and county regulation as it relates to Program Integrity in NC Fast and Lotus Notes (Onbase) systems. Continuously innovates training to improve the quality of work and help staff become more proficient in Program Integrity processes and policy.

2

20%

•

Analyzes review audits based on QA tools to ensure alignment with state and federal standards and policies. Conducts statistical analysis of quality reviews for Program Integrity trends.  Communicates the results to the Department Program Integrity Manager to address findings and resolutions. Collaborates with internal partners to assist in clarifying and communicating changes in State and County policies, processes, and systems to improve proficiency and best practices within Program Integrity.

3

15%

•

Keeps abreast of state and federal policy changes to ensure changes are understood and implemented based on overpayment period.  Participates in webinars, audits, policy update meetings, and trainings.  Effectively communicates with other program staff by conducting presentations in their area, as it relates to Program Integrity.

4

5%

Position(s) may perform other duties in addition to the above as assigned by management.

*IMPORTANT* In the event of an emergency, as determined by the County Manager or designee, participation in preparedness and response operations should be expected. Employee may be required to fill a temporary assignment in a role different from standard duties, work hours and/or work location in preparation for, during and after the emergency. Employee may also be required to participate in relevant exercises and regular preparedness training.

Career Level Dimensions

Career Level:

P2

Career Level Description:

Professional Level 2

•

Works independently on projects/assignments that impact Work Group results.

•

Work is generally supervised and involves periodic process checks.

•

Responsible for making adjustments or recommended enhancements in systems and processes to solve problems or improve effectiveness of the Work Group.

•

Typically communicates within or outside the Work Group to provide information requiring some explanation or interpretation to reach agreement.

•

May provide guidance and assistance to entry level professionals or support staff.

•

Requires practical knowledge of the Work Group typically obtained through advanced education combined with experience.

Qualifications

•

Bachelor's degree

•

Two years of job-related experience

•

Equivalent education and experience are accepted

•

Bachelor's Degree

Bachelor's degree in Human Services, Health or related field. 

•

3 Years

Extensive Program Integrity knowledge in all ESS required programs.

•

2 Years

Advanced level skills working in NC Fast.

•

Detail-oriented with strong critical thinking, analytical, and problem-solving skills.

•

Knowledge of relevant social services policies, procedures, and strategies to comply with effective local, state, or federal mandates.

•

Ability to identify complex problems and reviewing related information to develop and evaluate options and implement solutions.

•

Ability to identify measures or indicators of system performance and the actions needed to improve or correct performance.

•

Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

•

Exceptional interpersonal skills, verbal communication and customer service skills.

An individual must be able to perform each essential duty satisfactorily to perform this job successfully. The requirements listed above 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.

Competencies

Attention to Detail

Thoroughness in accomplishing a task through concern for all the areas involved, no matter how small. Monitors and checks work or information and plans and organizes time and resources efficiently.

Communication

Creates an atmosphere in which timely and high-quality information flows smoothly up and down, inside and outside of the organization; encourages open expression of ideas and opinions.

Enforcing Laws, Rules & Regulations

Enforces governmental laws, rules, and regulations, and initiates enforcement actions in a way that the public perceives as fair, objective, and reasonable.

Quality Assurance

Produces results or provides service that meets or exceeds organizational standards. May audit the work of others to ensure quality standards are met.

Speaking

Effectively transfers thoughts and expresses ideas orally or verbally in individual or group situations.

Writing

Conveys ideas and facts in writing using language the reader will best understand.

Integrity

Act with honesty, transparency and respect in our interactions with co-workers and those we serve. Adhere, without exception, to laws, policies, procedures and professional standards.

Accountability

Establish high-quality standards for work. Add value. Measure results and hold self and others accountable for making progress toward desired outcomes. Take a logical and data-driven approach to decision-making.

Diversity

Believe that different backgrounds and experiences strengthen the organization and produce better results. Value inclusion across race, gender, age, religion, identity and experience, and strive to reflect in our workforce the diversity of our community.

Collaboration

Foster a work culture in which different ideas and opinions are encouraged and expected. Listen carefully and speak thoughtfully. Work together toward shared goals with mutual respect and cooperation.

Continuous Improvement

Continuously improve work processes and products. Provide a safe environment to be innovative and creative and try new things. When things don't go as planned, use it as an opportunity to learn, regroup and begin again. Provide time and resources for individuals to grow and develop both personally and professionally.

Wellness

Take proactive steps to be physically fit and healthy, emotionally strong, financially secure and socially fulfilled, while inspiring and empowering others to do the same.

Service Orientation

Commit to making a difference within the community. Actively engage in and enjoy our work. Deliver services that exceed expectations, with courtesy, politeness and sensitivity to the experiences, concerns and feelings of all co-workers and customers.

ADA Checklist

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

Standard ADA Selection:

Office Environment

Standing

X

Walking

X

Sitting

X

Lifting/Carrying 0-10 pounds

X

Lifting/Carrying 10-20 pounds

X

Lifting/Carrying 20-50 pounds

X

Lifting/Carrying 50-100 pounds

X

Pushing

X

Pulling

X

Climbing

X

Balancing

X

Stooping

X

Kneeling

X

Crouching

X

Crawling

X

Reaching

X

Handling

X

Grasping

X

Fingering

X

Feeling

X

Talking

X

Hearing

X

Visual Perception

X

Repetitive Motions

X

Eye/Hand/Foot Coordination

X

Memorization/Concentration

X

Learning/Knowledge Retention

X

Preparing/Analyzing Numerical Figures

X

Use of Interfaced Commmunication Devices (Phone, Computer, Radio etc.)

X

Analyzing/Examining/Testing Data

X

Emotional/Behavioral Self-Regulation

X

Interacting with Others

X

Comprehension

X

Organization

X

Decision Making

X

Comprehension

Understand complex problems and collaborate to explore alternative solutions

Organization

Organize actions to complete sequential and/or routine tasks

Decision Making

Make decisions that have an impact on the individual's work

Communication

Communicate and explain a variety of information

Extreme cold

X

Extreme heat

X

Humid

X

Wet

X

Noise

X

Hazards

X

Temperature Change

X

Atmospheric Conditions

X

Vibration

X

Computers/Monitors

X