Specialized quality control work for the Department of Social Welfare involving review and analysis of Medicaid payments to service vendors. The role includes analysis and evaluation of the claims processing and quality control procedures of the Department's fiscal agent which handles vendor claims.
Incumbents operate with considerable independence of action and perform many duties in the field.
Work is performed under the supervision of a Social Welfare Quality Control Supervisor. Areas of audit concern include eligibility, proper documentation, fees and payments, timeliness, and utilization of third party payor liability. Notifies fiscal agent of errors and necessary corrective actions. Analyzes delivery and payment system for potential problem areas and recommends improvements. Reviews and recommends changes in policies and procedures.