STATE CLASSIFICATION JOB DESCRIPTION


Salary Group B17

Class No. 5526

QUALITY ASSURANCE SPECIALIST I

GENERAL DESCRIPTION

Performs routine (journey-level) quality assurance work.  Work involves planning, developing, and administering internal quality assurance and compliance activities.  Works under moderate supervision, with limited latitude for the use of initiative and independent judgment.

EXAMPLES OF WORK PERFORMED

Develops and implements quality assurance programs.

Plans and organizes case review assignments.

Conducts case and quality control reviews of programs.

Verifies information received from case readings, sources, and clients.

Participates in corrective action planning and service improvement activities.

Identifies cases for investigation of potential fraud and for potential recoupment and restitution.

Reviews and analyzes cases, notes deficiencies, and extracts data to be verified; collects performance data; identifies adverse trends; and determines compliance with service delivery standards, program requirements, and policies and procedures.

Documents review findings.

Communicates final determination of case review to appropriate staff.

May analyze quality control error findings for trends or patterns.

Performs related work as assigned.

GENERAL QUALIFICATION GUIDELINES

Experience and Education

Experience in social service financial eligibility determination, auditing, or investigating work.  Graduation from an accredited four-year college or university with major coursework in social work or a related field is generally preferred.  Experience and education may be substituted for one another.

Knowledge, Skills, and Abilities

Knowledge of federal and state program policies and laws, of financial and medical eligibility program policies, and of quality control procedures.

Skill in interviewing, in analyzing data, and in the use of a computer and applicable software.

Ability to apply program and quality control policies and procedures; to ensure compliance with state and federal regulations; to select, analyze, and evaluate information from case records in relation to eligibility criteria; and to communicate effectively.


State Auditor’s Office

Revised 9-1-15