Medicaid Quality Control Case Reviewer

City of New York; New York (NY); On-site; USD 62,000 - 71,000; Full time

Job summary

City of New York.is seeking a Principal Administrative Associate II to function as a Quality Control Case Reviewer in the Medicaid Quality Control Unit. You will review MAP MICSA and HCSP cases, verify data accuracy, and prepare audit documentation for internal and external reviews.

The role requires a bachelor’s degree or equivalent with supervisory experience, and the work is conducted within the Office of Quality Assurance & Fiscal Integrity.

Qualifications

• A four-year high school diploma or its educational equivalent with four years of clerical/administrative experience, including supervisory experience.
• Bachelor's or equivalent with two years of related clerical/administrative experience; supervisory experience preferred.
• Associate degree and three years of related clerical/administrative experience including one year of supervisory experience.
• Equivalent combination of education and experience with required supervisory experience.

Responsibilities

• Conduct monthly review of MAP MICSA and HCSP cases from a sample set.
• Use HRA Viewer, WARM, eMedNY, SAVE and SOLQ to retrieve client information.
• Ensure sample auditable by preliminary inquiries and verify consistency of sample.
• Prepare case review summaries and document findings for external auditors.

Education

Bachelor's degree

Associate degree / 60 semester credits

High school diploma or educational equivalence

Education/experience equivalent substitution

Job description

City of New York.is seeking a Principal Administrative Associate II to function as a Quality Control Case Reviewer in the Medicaid Quality Control Unit. You will review MAP MICSA and HCSP cases, verify data accuracy, and prepare audit documentation for internal and external reviews.

The role requires a bachelor’s degree or equivalent with supervisory experience, and the work is conducted within the Office of Quality Assurance & Fiscal Integrity.