Healthcare Quality Assurance Analyst

Our goal is to solve problems and deliver results for our clients. At Cloud and Things, you can be a part of transforming the public sector’s IT environment. Our team is on the forefront of helping to solve the government's most complex IT challenges. If you are seeking a role that offers the opportunity to work on rewarding projects, consider a career with Cloud and Things.?



*This is an exempt position. Salary commensurate with experience*



Overview:

Location: Remote

Travel Requirements: Potential occasional travel to offices in Albany, NY and NYC.

Salary: $70,000 - $95,000


We are seeking a Healthcare Quality Assurance Analyst who will support our NYS client. This role will provide analysis expertise to evaluate the performance of the 1915© Children’s Waiver across NYS.


The ideal candidate for this role will have prior experience with NYS health and human services programs, specifically related to Medicaid, and strong Analysis and/or auditing experience with such programs.



Duties:

• Evaluate child/youth’s records for compliance to applicable regulations:
  • Clearly communicate evaluation requirements and follow up.
  • Evaluate documentation against applicable State/Federal regulations.
  • Collect data and documentation to support compliance findings.
  • Utilize technology to convert hard copy documentation to electronic and submit via secure file transfer.
  • Record, summarize, and communicate compliance findings for the Children’s Transformation Program.
  • Assist in determining trends in non-compliance.
  • Make appropriate and timely recommendations to project management.
• Assist with the ongoing operationalization of project’s processes and procedures.
• Assist with all internal and external reporting.
• Build and maintain relationships with stakeholders to provide a high level of customer service.
• Traveling to provider sites to perform case reviews.

Mandatory Qualifications:

• Bachelor’s degree in public health, healthcare management, psychology, human services, or related field, or an equivalent combination of advanced education, training, and experience will be considered.
• 2+ years of experience as a Healthcare Compliance Analyst, Auditor, Care Manager, or Medicaid Provider, in a role responsible for conducting oversight, compliance audits or chart reviews, or ensuring quality of care.
• 1+ year of experience with Medicaid fee-for-service and/or Managed Care billing.
• Proficiency in MS Excel, MS Word, MS Outlook, MS Visio, MS PowerPoint and MS SharePoint.
• Strong analytical and problem-solving abilities; able to evaluate data and make sound, evidence-based decisions.

Desirable Qualifications:

• Extensive knowledge of, and experience with, Home and Community-Based Services (HCBS) Waiver programs, including the 1915(c) NYS Children’s Waiver, either as a provider or compliance officer.
• Experience working with eMedNY, CANS-NY, UAS-NY, Medicaid Health Homes, Medicaid Managed Care Organizations (MMCOs), or other related programs/systems.
• Experience with NYS Medicaid billing, including the use of various Electronic Health Records (EHR) systems.
• Experience working with Office of Mental Health (OMH), Office for People with Developmental Disabilities (OPWDD), or Office of Children and Families (OCFS).
• Ability to manage time independently while meeting deadlines and adhering to high performance standards.
• Experience with compliance audits or chart reviews.
• Ability to work with and relate to staff and demonstrate active listening skills.
• Process oriented and results-driven work strategy.
• Ability to foster teamwork with all levels of management and staff.
• Ability to work well independently and within a team.
• Exceptional customer service relationship techniques, including superior verbal and written communication skills.
• Excellent accuracy and attention to detail.

Cloud and Things complies with all applicable federal, state, and local laws regarding recruitment and hiring. All qualified applicants are considered for employment without regard to race,?color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other category protected by applicable federal, state, or local laws.



AI-Assisted Resume Evaluation Notice

Cloud and Things – Talent Management



Notice to Candidates
Cloud and Things utilizes artificial intelligence (AI) tools to assist our recruiting team in evaluating candidate applications for streamlining; consistency, efficiency, and thoroughness. All hiring decisions are ultimately made by our human recruiting professionals.



How AI Is Used
Our AI tools assist by:

• Analyzing resumes against job requirements
• Supporting our recruiters in candidate data evaluation
• Ensuring consistent review standards across all applications

Important: AI serves as a support tool only. As noted above, all candidate selection and hiring decisions are made by experienced human recruiters. Your unedited resume will be processed by our AI tools as part of this evaluation.



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Cloud and Things Data Handling:

• Your information is processed securely and used exclusively for recruitment purposes
• Cloud and Things may store your resume in our Applicant Tracking System (ATS) indefinitely for future job matching opportunities
  • You may opt out of long-term ATS storage by emailing your name and your request to opt out of storing your resume in the ATS to: [email protected]
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• AI processing data is retained for a maximum of 90 days, after which it is deleted
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• Personal data is anonymized or minimized wherever possible during AI processing

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By submitting your application, you acknowledge this notice and consent to AI-assisted evaluation as part of our recruitment process. You may opt out only by choosing not to submit your resume for consideration.