Medicaid Quality Assurance Assistant
Why Sheboygan County?
It is our imperative to remain an inclusive workplace. Sheboygan County is committed to attracting, supporting, and retaining a culturally diverse workforce that represents our community. Sheboygan County Health and Human Services also strives to be a trauma informed organization which fully realizes the prevalence of trauma, recognizes the effects of trauma, and responds with trauma informed policies and practices, and we are looking for staff who will help us champion this journey.
Becoming a member of our growing team also means that YOU become our top priority. You will not only enjoy a dynamic work environment but a variety of perks including but not limited to the following:
◦ Generous benefits package and access to our free InHealth Clinic
◦ Time off: 15 vacation days, sick time and 10 paid holidays
◦ Other perks: Referral program, Wisconsin Retirement System, education discount, and much more!
What to expect:
The Medicaid Quality Assurance Assistant maintains responsibility for the review of Medicaid related documents 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 following duties are noted as most critical for this position but are not to be construed as exclusive or all-inclusive as other duties may be required and assigned.
ͦ Maintain knowledge of Federal and State rules, regulations and Administrative Codes that impact Medicaid; train staff to recognize and correct errors and ensure program compliance and accuracy
ͦ Perform Quality Assurance reviews on cases and contract provider records for compliance with Federal, State, and department policies, procedures and Administrative Codes; analyze the results of reviews and works with department staff on assisting with implementing corrective measure
ͦ Develop and maintain resources, network with outside agencies and attend training in order to maintain current knowledge of all rules and regulations enacted by Federal, State and local entities for Medicaid
ͦ Maintain all necessary documentation and evidence in compliance with audit and statutory requirements
ͦ Participate actively and effectively in development activities such as conference calls, professional meetings to include MH/AODA and Fiscal related Statewide and Regional meetings
ͦ Complete and maintain documentation and reports according to applicable requirements, Codes and policies
ͦ Participate in meetings, discussions, training, and activities, demonstrating orientation toward professional competence and continuous quality improvement; make recommendations when warranted
The successful candidate will meet the following requirements:
Two years of experience with individuals with a range of mental health and/or substance abuse diagnoses as well as knowledge and abilities including but not limited to the following:
ͦ Experience with MH/AODA Administrative Codes, Comprehensive Community Services (CCS) Administrative Codes, Emergency Mental Health Service Programs Administrative Codes, and Quality Assurance preferred
ͦ Display a high level of initiative, effort and commitment towards completing assignments efficiently and accurately; adapt easily to multiple projects, assignments, and deadlines
ͦ Understanding of federal laws, State statutes, and administrative rules which regulate the services provided
ͦ Coordinate functions crossing unit and departmental lines, involving outside counties and community agencies
ͦ Maintain effective working relationships with co workers, superiors, community partners, and the public
ͦ Ability to relate to people and to communicate effectively in both written and oral formats
ͦ Ability to exercise sound judgment in confrontational and stressful situations; maintain confidentiality
Applications will be accepted until position has been filled.