Quality Assurance Specialist

The Quality Assurance Specialist is responsible for ensuring compliance, accuracy, quality improvement, and regulatory adherence across Financial Management Services (FMS) programs. This position supports the organization's commitment to delivering high-quality services by conducting audits, monitoring program operations, analyzing trends, investigating compliance concerns, and identifying opportunities for process improvement.

1. → Maintains current knowledge of federal, state, payer, and organizational requirements governing Financial Management Services programs.
2. →Conducts routine and targeted audits of participant, attendant, payroll, enrollment, compliance, and administrative records to ensure accuracy, completeness, timeliness, and regulatory compliance.
3. →Identifies deficiencies and works collaboratively with program staff to implement corrective actions.

1. Monitors program activities to ensure adherence to agency policies, contractual obligations, program standards, HIPAA requirements, and regulatory guidelines.
2. Conducts record reviews, interviews, and validation activities to verify that procedures are being followed consistently and effectively.

1. Reviews outgoing reports, corrective action plans, grievance responses, critical incident reports, fraud investigations, and other communications before submission to external stakeholders.
2. Ensures documentation is accurate, complete, professionally written, and compliant with program requirements.

1. Performs audits of electronic systems and databases, including CellTrak, Netsmart, Sendata, payroll systems, document management systems, and other technology platforms.
2. Reviews data accuracy, timeliness of documentation, and compliance with established procedures.
3. Identifies system-related issues and collaborates with operational and information technology staff to resolve discrepancies.

1. Maintains detailed records of audits, investigations, corrective actions, quality reviews, and compliance monitoring activities.
2. Produces clear, accurate, and timely documentation in accordance with departmental standards and regulatory requirements.

Performs additional quality assurance, compliance, and operational support activities as assigned by the FMS Quality Assurance Manager.