Quality Assurance Nurse evaluates the quality of patient care. Monitors compliance with current laws, process improvements, and implementation of clinical best practices. Being a Quality Assurance Nurse reviews and analyzes customer complaints. May need to help train staff on new or improved clinical practices. Additionally, Quality Assurance Nurse requires an associate's degree/bachelor's degree and is licensed to practice nursing. Typically reports to a manager or head of a unit/department. To be a Quality Assurance Nurse typically requires 2 to 4 years of related experience. Gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. (Copyright 2024 Salary.com)
CAPS – Provider Relations Quality Assurance & Payments Manager
Closing Date: April 19, 2024
Salary: $51,310.72 - $68,677.24
Salary is commensurate with education and experience.
Job Code: GSP133
Pay Grade: M
This posting is a readvertisement. Previous applicants do not need to reapply. All submissions are being considered.
Job Summary:
The CAPS Provider Relations Quality Assurance and Payments Manager will report to the CAPS Provider Relations Director and provide front-line management of a team responsible for conducting the programmatic and operational activities of the quality assurance and payments function/section of the Childcare and Parent Services (CAPS) program within the Department of Early Care and Learning (DECAL).
The Quality Assurance and Payments team will ensure provider compliance with billing for care provided for families who participate in the CAPS program. This team provides oversight of the payment process for CAPS providers and works closely with the payment vendor to resolve matters related to payment status, errors, and processing. Additionally, the team will perform complex research to investigate payment errors, if applicable. The team evaluates various reports to determine if payments align with Child Care Development Fund (CCDF) requirements. The manager handles suggesting system enhancements to automate system logic to prevent issuance of scholarships to families who are not eligible for CAPS to reduce error rates in payments.
Job Responsibilities:
· Assists with managing the operation of a comprehensive system of child care financial assistance and social services for families with a focus on innovation and system building, as well as improved performance and accountability.
· Leads a team responsible for oversight of the provider payment processing, ensuring service delivery adheres to all federal and state requirements.
· Provides oversight of the Provider Relations Quality Assurance and Payments team and conducts the following:
o Ensure proper payments are made based on CAPS policy.
o Collaborate with payment vendor to research payment issues and ensure successful payment processing.
o Assign reviews of data abnormalities to correct or address errors in provider profiles or payments. Provide supervision of follow-up research to address questions related to complex provider scenarios.
Agency Required Qualifications:
Bachelor's degree in business or related field from an accredited college or university AND Six years of experience related to area of assignment. Note: An equivalent combination of education and job specific experience that provided the knowledge, experience and competencies required to successfully perform the job at the level listed may be substituted on a year-over-year basis.
Agency Preferred Qualifications:
Bachelor’s degree from an accredited college or university in Accounting, Finance, Business Administration, Data Analytics, or related discipline; and the following:
o Three years of supervisory experience in a related field.
o One or more years of experience analyzing data to make programmatic or policy decisions.
o One or more years of experience defining the business requirements and recommending a technical approach to meet them.
o One or more years of experience issuing financial compensation to customers.
Technical Competencies:
· Ability to exercise judgment, decisiveness and creativity in situations involving the evaluation of information against sensory, judgmental, or subjective criteria, as opposed to that which is clearly measurable or verifiable.
Physical Position Requirements:
· Work is typically performed in an environment with intermittent sitting, standing, or walking in various settings.
· The ability to speak clearly, to hear and understand at a normal conversational level, and to receive detailed information through verbal communication.
· Close visual acuity to perform an activity such as: preparing and analyzing data; viewing a computer terminal; extensive reading and visual inspection.
· Full range of hand and finger motion for data entry purposes.
Recruitment Pool: All qualified applicants
Bright from the Start: Georgia Department of Early Care and Learning is a family-friendly employer, offering flexible work schedules (at supervisory discretion) and a comprehensive compensation package, to include healthcare, retirement, 401-k match, and elective options for dental, vision, AD&D, short and long-term disability, and life insurance. Bright from the Start: Georgia Department of Early Care and Learning is an equal opportunity employer and drug-free workplace. A background check will be completed upon hire, which may consist of any or all of the following: criminal and employment histories, credit history (as applicable to the position), education credentials, and motor vehicle driving records.
If you are an individual with a disability who may require assistance or other reasonable accommodation in order to participate in the selection process for this position, you may contact our HR department at 678-879-2993. Due to the volume of submissions received by this office, information concerning application or interview status cannot be provided in writing, over the phone, or in person. All applicants who submit a complete application package will be considered but may not necessarily receive notification or an interview. The job posting may be subject to being closed at any time without notice. Only those qualified candidates who are selected for an interview shall receive notification upon the filling of this vacancy.
Bright from the Start: Georgia Department of Early Care and Learning is an equal opportunity employer.