This is quality control work involving statewide public assistance programs. Case reviews are conducted within federally mandated time frames. Failure to meet time frames can result in federal administrative penalties.
Review and evaluate approximately 31 different public assistance programs. This requires extensive program knowledge.
Nature and Scope
Class incumbents report to the Program Compliance Supervisor and are responsible for the conduct of quality control reviews/audits of various public assistance cases including, but not limited to Food Stamps, Aid to Families with Dependent Children (AFDC) and the multiple Medicaid programs. Incumbents conduct comprehensive reviews and analysis of statistically selected case files to evaluate Division of Social Services compliance with program objectives and federal/state standards and program regulations. A significant aspect of the work involves expertise in interpretation and application of program rules, regulations, policies and procedures. Work requires incumbents to conduct the review at the client's home. Incumbents are responsible for identifying factors which cause or contribute to errors rooted in the eligibility determination process and for recommending corrective actions which specifically address the problem. Emphasis is placed on the accuracy of the incumbents' decisions in order to avoid federal monetary sanctions since work is subject to federal subsample audit. Incumbents must keep abreast of frequent policy and program changes at the federal and state level.
Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.
Review/audit public assistance case records and document the nature of all errors so that: the total error rate can be determined.
Present program methods and procedures can be evaluated; and more effective methods and procedures can be developed and implemented as needed.
Examine case records to include mathematical computations of incomes, resources and expenses relative to receipt or denial of assistance.
Schedule home visits with program recipients and interview to verify and/or supplement case record information.
Make written, telephone and personal collateral contacts with employers, State and Federal agencies, schools etc., in order to substantiate and/or supplement case record information.
Analyze case determinations for compliance with applicable laws, rules, regulations, policies and procedures of the assistance programs. Completes required federal schedule for each case assignment. Write a summary for each case reviewed detailing the nature of errors as applicable.
Analyze data accessed from automated information systems.
Maintain records of cases received with particular emphasis given to review initiation and completion dates.
Attend staff meetings to discuss laws, rules, regulations and policy interpretations and revisions.
Make recommendations regarding possible solutions to recurring errors.
Knowledge, Skills and Abilities
The intent of the listed knowledge, skills and abilities is to give a general indication of the core requirements for all positions in the class series; therefore, the KSA’s listed are not exhaustive or necessarily inclusive of the requirements of every position in the class.
Knowledge of interviewing techniques to include the ability to obtain sensitive information.
Knowledge of the policies, procedures and regulations of public assistance programs.
Knowledge of recordkeeping procedures, scheduling practices, and reports preparation.
Skill in the use of basic statistics to include averages and percentages.
Skill in interpretation and application of laws, rules, policies, procedures, and regulations and application of same to public assistance.
Skill in interpreting and analyzing data received from automated information systems.
Ability to deal effectively with persons having varied educational and/or socio-economic backgrounds.
Ability to deal effectively with stressful and sometimes emotional situations.
Ability to develop recommendations for corrective action.
Ability to access data from automated information system.
Ability to work within federally mandated deadlines.
Ability to work independently.
Ability to perform arithmetical calculations.
JOB REQUIREMENTS for Program Compliance Specialist Applicants must have education, training and/or experience demonstrating competence in each of the following areas:
Six months experience in interviewing which includes using structured or unstructured interview techniques to obtain facts, explore issues and identify courses of action.
Six months experience in making recommendations for continuation or changes to operations, programs, services, policies or procedures based on findings.
Six months experience in determining compliance with laws, rules, regulations, standards, policies and procedures.
Knowledge of quality improvement such as evaluating the quality of services, identifying problems and needs and recommending corrective action and improvements to ensure optimum service delivery, goals and objectives are met and ensure compliance with applicable laws, rules, regulations and standards.