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

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.