QUALITY CONTROL CASE REVIEWER

NYC Department of Social Services; New York (NY); On-site; USD 57,000 - 67,000; Full time

Job summary

An established industry player is seeking a Quality Control Case Reviewer to join their team. This role involves ensuring the accuracy of Medicaid case reviews, conducting audits, and preparing documentation for external reviews. The ideal candidate will possess strong analytical and communication skills, with a solid understanding of state policies and procedures. This full-time position offers a competitive salary and the opportunity to contribute to the integrity of social services programs. Join a dedicated team committed to making a difference in the community!

Qualifications

• 3 years of relevant experience with a Baccalaureate degree.
• Experience in supervisory roles is essential.

Responsibilities

• Ensure review sample accuracy and conduct case reviews.
• Prepare case review summaries for audits.

Skills

Knowledge of State policies

Auditing experience

Documentation skills

Database use (WMS, EMEDNY, SOLQ, SAVE)

Analytical skills

Communication skills

Education

Baccalaureate degree

Associate degree

High school diploma

Tools

Microsoft Office

Job description

Join to apply for the QUALITY CONTROL CASE REVIEWER role at NYC Department of Social Services.

Job Overview

The DSS Accountability Office (DSS-AO) is responsible for protecting the integrity of social services programs administered by the New York City Department of Social Services (DSS) and ensuring compliance with all statutory, regulatory, and contractual standards.

Within the Office of Quality Assurance & Fiscal Integrity, the Medicaid Quality Control Unit (MAQC) conducts complex internal audits and quality control reviews to identify programmatic deficiencies, analyze error trends, and determine corrective actions. The unit ensures continuous adherence to state and federal regulations, with error rates based on Medicaid policies and procedures.

Position Details

We are recruiting for one Principal Administrative Associate II to serve as a Quality Control Case Reviewer. Responsibilities include:

1. Ensuring review sample accuracy through preliminary inquiries and case reviews, verifying auditable reports, and sharing relevant documents with supervisors.
2. Conducting monthly reviews of various Medicaid cases, retrieving client information from multiple databases such as HRA Viewer, COLD, EMEDNY, SAVE, and SOLQ.
3. Reviewing Medicaid procedures and policies to identify contradictions and reporting findings to supervisors.
4. Preparing case review summaries and documentation for audits and external review processes.

Work Details

Location: 4 WTC NY, NY

Schedule: Monday to Friday, 9 AM - 5 PM

Minimum Qualifications

• Baccalaureate degree with three years of relevant experience, including supervisory experience, or
• Associate degree with four years of relevant experience, including supervisory experience, or
• High school diploma with five years of relevant experience, including supervisory experience, or
• Equivalent education/experience with one year of supervisory experience.

Preferred Skills

• Strong knowledge of State policies and agency procedures.
• Experience in auditing and error identification.
• Proficiency in documentation, responding to auditors, and interpreting directives.
• Skills in database use (WMS, EMEDNY, SOLQ, SAVE), Microsoft Office, and staff supervision.
• Excellent analytical and communication skills.

Additional Information

This position is open to qualified persons with disabilities under the 55-a Program. Indicate interest in your application.

Eligible for federal and state loan forgiveness programs; more info at https://studentaid.gov/pslf/.

NYC residency required within 90 days, with exceptions for certain city employees.

The City of New York is an equal opportunity employer committed to diversity and inclusion.

Compensation

$57,976.00 – $66,672.00

Additional Details

• Seniority Level: Mid-Senior level
• Employment Type: Full-time
• Job Function: Administrative
• Industry: Government Administration