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State of Washington Classified Job Specification

QUALITY CONTROL SPECIALIST

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QUALITY CONTROL SPECIALIST
Class Code: 165E
Category: Financial Services
Salary Range: 56


Definition

Conducts state and federally mandated independent audits of public assistance programs, including, but not limited to:  Medicaid, Children’s Health Insurance Program, Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families/WorkFirst Program, Child Care and Development Fund Program, and other cash programs, to determine compliance with Federal and State laws and regulations. Audits include the review and investigation of cases including telephone or in-person client interviews and contact with service providers, and/or collateral contacts to measure the validity of eligibility and benefits issued.

Typical Work

Analyzes and evaluates records of assigned cases; identifies case facts related to conditions of eligibility and payments; researches facts against laws, regulations, waivers, and guidelines to determine program and administrative compliance; identifies inconsistencies and/or deficiencies and suggests opportunities for improved performance outcomes;

Investigates complaints; in accordance with audit or project plans, conducts investigations and targeted audits of programs, specific services, individual DSHS offices and/or individual cases; audits eligibility/payment denials, terminations and withdrawals to validate negative case actions;

Conducts home visits or telephone interviews with clients, regulated service providers, attorneys and others to obtain data, resolve discrepancies, and explain processes and services. On site visits and interviews can be mandatory and occur outside of the home.

Makes definitive determination of program eligibility, timelines, accuracy, completeness, and compliance; determines potential for federal sanctions; submits audit findings and recommends corrective actions; evaluates agency responses and submits supplemental reports or rebuttals;

Prepares comprehensive reports of findings and conclusions; recommends strategies and changes to programs and processes to maintain consistent compliance and reduce errors;

Compiles information for and testifies as required at case hearings or in court;

Develops audit plans; works with information technology staff to develop and test automated tracking, data compilation and reporting applications related to duties;

Performs other related work as required.

Knowledge and Abilities

Knowledge of: State and Federal laws, regulations and guidelines for public assistance programs, including but not limited to, Medicaid, Medical Assistance Programs, Food Stamp Program, Temporary Assistance to Needy Families Program, Child Care Program; and General Assistance Programs, principles and methods of automated data collection, record keeping, analysis and evaluation; principles and practices of effective investigative interviewing; inspection and measurement techniques; administrative procedures and enforcement methods of relevant federal or state programs; philosophy of public assistance; principles of individual and group behavior; social and economic conditions and their effect upon individuals

Ability to: analyze, compare and evaluate case records, program laws, regulations and guidelines; interview effectively; reconcile conflicting information; reach sound conclusions; develop effective strategies to conduct studies and resolve problems; communicate concisely and persuasively both orally and in writing, including effectively explaining complex technical and legal material in a manner appropriate to the audience; develop and maintain positive working relationships; establish rapport with individuals from diverse backgrounds in potentially hostile situations; work with a high level of independence; function effectively in a stressful environment; perform required mathematical computations and analyses.

Legal Requirement(s)

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.

Persons legally authorized to work in the U.S. under federal law, including Deferred Action for Childhood Arrivals recipients, are eligible for employment unless prohibited by other state or federal law.

Desirable Qualifications

A Bachelor's degree

AND 

Two years' experience as a Financial Services Specialist 3, 4, or 5 or a WorkFirst Program Specialist, or WorkFirst Program Supervisor.  One year experience must have been gained within the State of Washington.

Additional qualifying experience determining eligibility for public assistance programs may be substituted, year for year for education. Qualifying experience can only be gained in a Community Services Office, Welfare Office, or Public Assistance Office.

OR

Equivalent education/experience.

Class Specification History

New class effective May 1, 1963
Revised December 22, 1970; Revises minimum qualifications
Revised September 19, 1975; Revises definition, minimum qualifications, general revision
Revised December 10, 1976; Revises minimum qualifications
Revised November 4, 1977; Revises minimum qualifications
Revised December, 1978; General revision
Revised September 11, 1987; Revises definition, minimum qualifications, title change (formerly
Case Reviewer)
Adopted May 10, 2007, effective July 1, 2007; salary adjustment; revised class code, definition
Revised May 7, 2013; desirable qualifications
Revised definition adopted March 14, 2014, effective March 15, 2014
Revised typical work and desirable qualifications, effective April 15, 2014
Revised definition; final adoption May 8, 2014, effective May 9, 2014

Revised Legal Requirements; effective June 6, 2024, due to adopted legislative action.