Quality Audit Specialist

ResCare Community Living

Our Quality, Risk and Compliance teams focus on maintaining compliance and auditing to mitigate risk for our operations. This keeps the company in compliance with State, Federal and overall company requirements, but most importantly to keep our clients safe and to help them live their best life. If your passion is ensuring service quality and fostering compliance, apply today!

The Quality Audit Specialist will ensure that qualified providers of Medicaid services meet the federal or state standards for the provision of car. Auditing of qualified provider credentialing will be conducted on a frequency as determined by operational need. The reviewer will conduct the audits with a focus on providing a report on the operations compliance with State, Federal and company requirements as it relates to Medicaid qualified provider credentialing for the state of WV. The purpose of this role is to , foster compliance with internal and external requirements, and provide education for field operations regarding requirements and the audit process
• Conduct Qualified Provider Quality Audits using the required tool(s), based on service line and applicable tool
• Report findings to Executive Director and Regional Director upon conclusion of the audit.
• Provide timely and accurate reports to Operations
• Immediately report areas of significant deficiencies, quality concerns to supervisor and operation leadership
• Communicates directly with the Executive and Regional Directors any reportable findings or issues identified during the review that could potentially put the Company at risk.
• Attend provider monthly calls hosted by the auditing entity to remain current on policy revisions and FAQ guidance for service providers.
• Other Duties as assigned by the Regional Director.

• One to three years prior work experience in Community Living, HomeCare, Home Health, Hospice or Rehab Without Walls required
• Prior experience in conducting audits/quality reviews or experience in WV IDD Waiver services preferred
• Must be able to work independently
• Requires excellent written and oral communication skills
• Proven ability to manage multiple priorities
• Working knowledge of regulatory requirements for assigned Line of Business
• Excellent computer skills including Microsoft Word, Excel and PowerPoint
• Must be willing to work flexible hours
• Requires up to 100% travel across multiple states
• Reviews will be completed in the operations to include residential homes, day programs, host/foster family homes, client homes and offices
• Remote work such as developing reports and preparation can be completed at home offices