Quality Assurance Specialist

Job Description

Job Description

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.

Key Responsibilities:

Quality Assurance Reviews and Audits

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.

Compliance Monitoring

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.

Quality Review of Reports and Correspondence

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.

Data Systems Auditing

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.

Documentation and Reporting

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.

Other Duties

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

Skills & Requirements:

• Bachelor’s Degree in a behavioral science, human services or business administration, healthcare administration, public administration, nursing, or a related field preferred.
• Minimum of two (2) years of experience in quality assurance, compliance, auditing, healthcare administration, human services, case management, program monitoring, or a related field.
• Experience with HIPAA compliance, fraud prevention, quality improvement initiatives, or regulatory audits.
• Proficiency with Microsoft Word, Excel, SharePoint, PowerPoint, OneDrive, Outlook, and Teams.
• Experience with electronic medical records, participant databases, payroll systems, and document management systems.
• Strong analytical and critical-thinking skills.
• Excellent written, verbal, presentation, and interpersonal communication skills.

What we offer:

• 401(k)
• Tuition Assistance
• Health & Dental
• Paid Vacation/Sick Time
• 10-12 Holidays per year
• Reimbursement of mileage and travel expenses
• Excellent supportive business and information tools

The base pay for this position ranges from $47,500 to $57,500 and will vary based on factors such as skills and experience. Base pay is one part of the Total Compensation that JEVS Human Services provides to recognize employees for their work. JEVS provides competitive Benefits; we believe that benefits should support you at work and at home. Please visit the benefits page of our careers site for more details.

At JEVS, we are committed to ensuring all our employees feel included, valued, appreciated and free to be who they are at work. We cultivate a culture where differences are valued, and we are putting resources and attention towards improving employee engagement, retention, and promotion of our talented staff.

Diversity, inclusion, and equity are core principles that guide how we cultivate leaders, build our teams, and create an environment that is the right fit for JEVS Human Services’ employees, our community partners, and the individuals we serve.

For more information about what it’s like to be a part of the JEVS team, visit our careers page at https://www.jevshumanservices.org/careers/

Qualified individuals with disabilities are encouraged to apply; reasonable accommodations will be provided. Please contact your recruiter if you are in need of an accommodation during the interview process.

JEVS Human Services is committed to ensuring equal employment opportunities. The Agency will not engage in or tolerate unlawful discrimination (including any form of unlawful harassment) on account of a person’s gender, gender identity, age, race, color, religion, creed, sexual preference or orientation, marital status, national origin, ancestry, citizenship, military status, veteran status, disability, or membership in any other protected group. Qualified individuals with disabilities are encouraged to apply; reasonable accommodations will be provided.