Quality Assurance Manager - Healthcare jobs in Georgia

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:

• Ensure weekly payment process is performed to ensure timely payments to providers participating in the CAPS program.

o   Ensure proper payments are made based on CAPS policy.

o   Collaborate with payment vendor to research payment issues and ensure successful payment processing.

• Manage and assign staff to respond to and correct errors in payments. Provide support related to adjustments (recovery or credit) related to improper payment matters.

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.

• Designate staff to conduct Family Child Care Learning Center capacity reviews.
• Validate provider level entries. Implement strategies to ensure system level compliance with CCDF regulations, CAPS practices, and emerging federal guidance on subsidy operations.
• Review entries, reports, data, and other inputs, as well as outputs. 
• Identify and assign work related to issues with scholarship errors or batching errors from Gateway to provider billing system.

• Oversee maintenance of standard operating procedures for team and continuing education to ensure compliance with procedures.
• Conduct quality assurance reviews on team’s work procedures and provides feedback on performance improvement when needed.
• Strategically plans and manages region workload, in collaboration with CAPS Provider Relations Director, to accomplish DECAL mission and goals.
• Work in close collaboration with Program Administration, Scholarship Administration, and Family Support sections of the CAPS division to ensure seamless service delivery to all families and providers, and exemplary customer service.
• Analyze and assess the effectiveness of existing programs to ensure the identified outcome measures are achieved while driving continuous improvement efforts.
• Interview, hire, direct, train, evaluate the performance of, and after proper consultation, when necessary, discipline and discharge employees.
• Facilitate communication within the division and with other divisions of the agency, such as the audits and compliance and legal divisions on a specific case level as well as on a procedure/policy level.
• Provide general customer service support to customers, child care providers, general public, partner agencies and stakeholders who call the CAPS customer service number.
• Prepare and present periodic briefings on regional progress towards established goals and initiatives to the CAPS Provider Relations Unit Director.
• Participate in cross-divisional projects and committees, focus groups, and community presentations as assigned.

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:

• Excellent oral, written, analytical, presentation and interpersonal communication skills.
• Advanced skills in Microsoft Word, Excel (e.g., VLOOKUP’s and pivot tables), and PowerPoint
• Intermediate skills in SharePoint and information databases.
• Ability to interpret statistical data and make relevant recommendations regarding work processes.
• Ability to complete analysis to inform agency policies on how the agency meets CCDF priorities.
• Ability to evaluate program and process effectiveness.
• Ability to use data to problem solve and to inform the design of business processes.
• Understanding of how data systems interact and ability to troubleshoot data discrepancies.
• A comprehensive understanding of early care and education settings, as well as both state and community programs and resources for eligible families.
• Strong knowledge/experience of program development and implementation.

·        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.