IM Case Control Reviewer

Description

Classification Purpose: The primary purpose of the IM Case Control Reviewer classification is to conduct internal and external reviews of public assistance cases to determine compliance with quality standards mandated by local, state and federal laws and regulations.

Job Duties: Review and analyze errors found in case records in database and case files as identified by state agencies. Audit data in case records and files against established local, state and federal eligibility guidelines for a variety of social service programs such as cash assistance, food stamps, Medicaid and other programs. Determine accuracy of approval and payment of benefits. Conduct research to determine causes of errors, to correct errors or to avoid errors in approving eligibility for local, state and federal public assistance. Research codes and eligibility guidelines for local, state and federal social service program. Contact third parties and customers for required verifications and information to correct errors. Calculate over/under payment for services. Communicate corrective actions taken and/or needed to staff. Provide verification to staff regarding eligibility guidelines.

Compile research and analysis. Enter and change data as needed in department databases. Prepare and submit reports regarding errors, discrepancies, corrective actions, etc. according to established timelines and requirements. Assemble, review and submit payment discrepancy packages. Appeal summaries or other documentation as required. Provide testimony in state hearings as required.

Make referrals and recommendations regarding corrective actions and/or changes in processes to avoid errors in the future. Enter internal referrals in department databases. Monitor referrals to ensure required corrections are completed. Maintain comprehensive knowledge of social service programs, policies and customer service issues. Attend training, participate in work groups and provide advice and direction to department staff regarding quality control and program policies. Maintain regular and predictable attendance.

These duties are illustrative only and you may perform some or all of these duties or other job-related duties as assigned.

Major Worker Characteristics: Knowledge of human relations; office practices and procedures; agency policy and procedures; government structure and process. Skill in word processing; equipment operation. Ability to define problems, collect data, establish facts and draw valid conclusion; calculate fractions, decimals and percentages; copy material accurately and recognize grammatical and spelling errors; complete routine forms; understand manuals and verbal instructions, technical in nature; proofread technical materials, recognize errors and make corrections; use proper research methods in gathering data; cooperate with coworkers on group projects; handle sensitive inquiries from and contacts with officials and general public; answer routine telephone inquiries from public; resolve complaints from angry citizens and government officials.

Minimum Class Qualifications for Employment: Any equivalent combination of relevant training and experience including but not limited to: An Associate's degree in social services or related field is required; supplemented by three (3) years of experience in social work, public assistance case management, or related field.

Additional Requirements: No special license or certification is required.

Supervisory Responsibilities: None required.

Unusual Working Conditions: N/A