Quality Assurance Specialist Job Wilmington area,Delaware USA,Quality Assurance

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.

Key Responsibilities:

Quality Assurance Reviews and Audits

Maintains current knowledge of federal, state, payer, and organizational requirements governing Financial Management Services programs.

Conducts routine and targeted audits of participant, attendant, payroll, enrollment, compliance, and administrative records to ensure accuracy, completeness, timeliness, and regulatory compliance.

Identifies deficiencies and works collaboratively with program staff to implement corrective actions.

Compliance Monitoring

Monitors program activities to ensure adherence to agency policies, contractual obligations, program standards, HIPAA requirements, and regulatory guidelines.

Conducts record reviews, interviews, and validation activities to verify that procedures are being followed consistently and effectively.

Quality Review of Reports and Correspondence

Reviews outgoing reports, corrective action plans, grievance responses, critical incident reports, fraud investigations, and other communications before submission to external stakeholders.

Ensures documentation is accurate, complete, professionally written, and compliant with program requirements.

Data Systems Auditing

Performs audits of electronic systems and databases, including Cell Trak, Netsmart, Sendata, payroll systems, document management systems, and other technology platforms.

Reviews data accuracy, timeliness of documentation, and compliance with established procedures.

Identifies system-related issues and collaborates with operational and information technology staff to resolve discrepancies.

Documentation and Reporting

Maintains detailed records of audits, investigations, corrective actions, quality reviews, and compliance monitoring activities.

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, One Drive, 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.

The base pay for this position ranges from $47,500 to $57,500 and will vary based on factors such as skills and experience. JEVS Human Services provides competitive Benefits; we believe that benefits should support you at work and at home.

JEVS is committed to ensuring all our employees feel included, valued, appreciated and free to be who they are 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.