Quality Control Reviewer

Economic Assistance Section - Remote in North Dakota - Medicaid Eligibility Quality Control (MEQC) Reviewer

About the Work Unit

• The Medicaid Eligibility Quality Control (MEQC) Program unit assesses eligibility determinations to assure accuracy and timeliness, preventing inappropriate payments and client delays. The program operates under guidance and oversight of The Centers for Medicare and Medicaid Services (CMS).
• The Supplemental Nutrition Assistance Program Quality Control (SNAP‑QC) unit administers the federally mandated state 'Quality Control System' that enhances payment accuracy and improves program administration by measuring program accuracy, assessing potential liabilities, developing policy and formulating improvement plans.
• It creates strong partnerships with state and zone staff to provide additional services such as non‑quality assurance case reviews, consulting, risk analysis, and recommendations for reducing or eliminating timeliness, eligibility, and payment errors.

ND Health & Human Services (HHS) is seeking a Quality Control Reviewer for its Economic Assistance Section. The role involves reviewing a sample of Medicaid and the Children’s Health Insurance Program (CHIP) case files to ensure compliance with federal and state laws, identifying errors or issues with the eligibility determination process, and recommending corrective actions to improve program integrity. The reviewer will work closely with the Medicaid policy administration team to ensure citizens receive the care and support they need while maintaining the highest standards of compliance and accountability.

• Audit medical assistance eligibility determinations for compliance with federal and state regulations.
• Conduct detailed analysis of investigation documents for accuracy and thoroughness according to applicable policy and regulations.
• Identify errors and determine specific causes by researching and applying appropriate federal and state rules and policies.
• Ensure error findings are accurate and supported by rules and procedures; collaborate with other MEQC team members to maintain consistency and accuracy.
• Communicate error findings to department staff and human service zones.
• Develop comprehensive audit finding reports with proposed recommendations.
• Collaborate with other MEQC team members to determine and develop audit methodology, performance measures, procedures, and audit proposals per federal and state regulations and guidance.
• Audit monthly negative samples of SNAP cases to ensure compliance with state and federal requirements.

The candidate must conduct thorough research, possess a deep understanding of Medicaid and SNAP policy, and be proficient in applying quality control procedures. Independence, initiative, time management, and attention to detail are essential.

• Four years of professional experience in SNAP and Medicaid, including policy knowledge and interpretation, and experience with investigations, auditing, or supervising staff performing such duties.
• Associate degree in human services, business, psychology, law, social work, nutrition, public health, or related field with emphasis in eligibility, plus six years of work experience administering or determining eligibility for human service economic assistance programs, including staff and budget management.
• Bachelor’s degree in a related field and four years of experience administering or determining eligibility for economic assistance programs.

• Prior lead or supervisory experience.
• Specialized experience in a quality control program.
• Familiarity with the MEQC sub‑regulatory guidance and CFR Title XLII.
• Experience entering data in SPACES.
• Exceptional self‑motivation and direction.
• Superior analytical, evaluative, and problem‑solving abilities.
• Ability to motivate in a team‑oriented environment.

Economic Assistance/Medicaid Programs include Temporary Assistance for Needy Families (TANF), Low Income Home Energy Assistance Program (LIHEAP), Supplemental Nutrition Assistance Program, Child Care Assistance Program, Basic Care Assistance Program, and Medicaid.

ND HHS…