Quality Control Reviewer, Roanoke-Piedmont Region, W0233 Compliance Division

Title: Quality Control Reviewer, Roanoke-Piedmont Region, W0233 Compliance Division

State Role Title: Community and Social Svc Specialists, All Other

Hiring Range: $55,000 - $65,000, commensurate with experience

Pay Band: 4

Agency: Department of Social Services

Location: PIEDMONT REGIONAL & LICENSING

Agency Website: dss.virginia.gov

Recruitment Type: General Public - G

Job Duties

At the Virginia Department of Social Services, we put people at the center of everything we do. We believe that every Virginian can live a life of dignity and that all voices, ideas and experiences contribute greatly to our pursuit of excellence. Inspired by continuous improvement, we commit ourselves to listening, learning and cultivating environments of trust, respect and positive engagement. Together, we are mission-driven, eager to achieve, and passionate about bringing the best of who we are to those we serve.

We design and deliver high-quality human services that help Virginians achieve safety, independence and overall well-being. We are a $2 billion agency – one of the largest in the Commonwealth of Virginia – partnering with 120 local departments of social services and 31 community action agencies, along with faith-based and non-profit organizations, to promote the well-being of children, adults, and families statewide. We proudly serve alongside 1,650 (state) and 12,200 (local) human services professionals throughout the Social Services System, who ensure that thousands of Virginia’s most vulnerable citizens have easy access to the services and benefits available to them.

In addition to a rewarding work experience, VDSS offers excellent health and life insurance benefits, pre-tax spending accounts, state funded Short- and Long-Term Disability, paid holidays, vacation, tuition assistance, free wellness programs, and a state retirement plan with options for tax-deferred retirement savings including employer matching – Employee Benefits.

About the Position:

The Quality Control Reviewer (QCR) for the Compliance Division conducts reviews of Local Department of Social Services (LDSS) cases in the Supplemental Nutrition Assistance Program (SNAP), Medicaid and other programs, as mandated or directed, to evaluate LDSS performance. Performance is measured by accuracy of expenditures, timeliness of benefit delivery, and compliance with federal mandates and state guidelines utilizing methodology that ensures program integrity and non-bias. The QCR identifies procedural misunderstandings by LDSS, describes performance trends, discrepancies in policy and refers questions of program abuse for fraud investigation. Review results provide a systematic method of measuring the validity of Virginia's performance in state and federally funded programs and assists with the development of program corrective action measures. As currently mandated by the United States Center for Medicare and Medicaid Services {CMS), reviews for Payment Error Rate Measurement {PERM) and Medicaid Eligibility Quality Control (MEQC) are alternated each fiscal year. The PERM and MEQC review findings are utilized by CMS and management in both VDSS and the Virginia Department of Medical Assistance Services (DMAS) in the statewide assessment of Medicaid program performance and appropriateness of expenditures. US Department of Agriculture (USDA) Food and Nutrition Service (FNS) utilizes QCR review findings to determine the SNAP error rate for Virginia which is compared to other state error rates. The work of Virginia's QC Reviewers is subject to re-review by USDA; approximately 50% of active case reviews, 40% of closed case reviews and 100% of case reviews that are not completed are re-reviewed. Errors in the QC Reviewer's work identified by USDA may cause the state error rate to increase because of the complex federal regression formula utilized by USDA. Therefore, an extraordinary level of programmatic knowledge as well as ability to thoroughly review and evaluate case records for accuracy is required for individuals in this position and will provide direct support to Benefit Programs in the way of data for programmatic corrective action and staff training.

Minimum Qualifications

Must have demonstrated:

• Ability to independently manage a deadline-oriented workload with a high degree of accuracy.
• Proficiency in Quality Control review policies and procedures.
• Ability to interpret and apply complex state and federal regulations and procedures.
• Good working knowledge of eligibility requirements for the S