Quality Assurance Assistant

Sheboygan County - Health & Human Services is a proud 2026 Gold recipient of Mental Health America’s Bell Seal for Workplace Mental Health, awarded for our commitment to employee mental health and well-being. Learn more about the Bell Seal at mhanational.org/bestemployers.

Here is why working at Sheboygan County is for you:
It is our imperative to remain an inclusive workplace. Sheboygan County is committed to attracting, supporting, and retaining a culturally diverse workforce that represents our community. Sheboygan County Health and Human Services also strives to be a trauma informed organization which fully realizes the prevalence of trauma, recognizes the effects of trauma, and responds with trauma informed policies and practices, and we are looking for staff who will help us champion this journey.

Becoming a member of our growing team also means that YOU become our top priority. You will not only enjoy a dynamic work environment but a variety of perks including but not limited to the following:

• Generous benefits package 
• Time off: 15 vacation days, sick time and 10 paid holidays
• Other perks: Referral program, Wisconsin Retirement System, education discount and more!

What to Expect: 

Provides quality assurance support for Medicaid-funded behavioral health programs within Health and Human Services Community Programs. This position reviews documentation and billing submitted by internal staff and contracted providers to ensure compliance with applicable Federal and State regulations, Administrative Code requirements, program standards, and County policies. The Quality Assurance Assistant identifies documentation and billing errors, supports corrective actions, assists with training and technical guidance, and collaborates with staff, vendors, and fiscal partners to promote accurate billing, program compliance, and continuous quality improvement.

The following duties are essential for this position.  However, they are not to be construed as exclusive or all–inclusive.  To be successful in this position, an individual must be able to perform each duty satisfactorily.  Other duties may also be required or assigned.

• Review Medicaid-related documentation and billing submitted by internal staff and contracted providers within the Behavioral Health Division to ensure compliance with applicable Federal and State regulations, Administrative Code requirements, program standards, and County policies.

• Conduct quality assurance reviews of case records, service documentation, and vendor billing for programs including CCS, CRS, CSP, and TCM to identify errors, omissions, inconsistencies, or noncompliance that may result in improper billing, incorrect client benefits, or audit risk.

• Document review findings, maintain supporting evidence, and communicate identified issues to staff, contracted providers, and supervisors; assist with implementation and tracking of corrective actions as directed.

• Maintain working knowledge of Medicaid-related rules, regulations, and program requirements, including DHS Chapter 36, and apply established standards consistently during reviews.

• Assist with training and technical support for Division staff and contracted providers regarding documentation standards, billing requirements, and common compliance errors to promote accuracy and prevent future issues.

• Review vendor billing submissions to ensure services billed align with authorized service plans, contractual terms, and program funding limitations; verify billing accuracy and financial responsibility.

• Coordinate routinely with contracted vendors, case managers, department leads, Accounts Payable, Accounting, Finance, and other internal staff to resolve billing questions, documentation discrepancies, and payment-related concerns.

• Monitor billing timeliness and completeness, ensure vendors submit required documentation and invoices within established deadlines, and ensure approved billing is forwarded to Accounts Payable accurately and on time.

• Maintain awareness of executed vendor contracts and apply contract provisions when reviewing services, billing, and compliance with program expectations.

• Complete and maintain required reports, logs, and documentation in accordance with audit, statutory, and departmental requirements.

• Participate in unit, department-wide, regional, and statewide meetings, trainings, and professional development activities related to Medicaid, behavioral health programs, fiscal processes, and quality assurance.

• Support continuous quality improvement efforts by identifying trends, recurring issues, and areas of risk; provide input and recommendations for process improvements when requested.

• Assist with annual and periodic compliance reviews, including verification of required documentation, credentials, and records for case managers, providers, and consumers, with major annual reviews typically conduct at year-end.

• Maintain regular and predictable attendance and perform related duties as assigned to support the mission and compliance responsibilities of Health and Human Services Community Programs.

Minimum Education: High school diploma or equivalent required. 
Minimum Experience: Two (2) years of experience in a human services, healthcare, fiscal, compliance, or administrative setting required. A combination of education and experience may be considered.
Minimum Certifications:  Comprehensive Community Services Certification preferred.
Other Requirements:  Experience with MH/AODA Administrative Codes, Comprehensive Community Services (CCS) Administrative Codes, and Emergency Mental Health Service Programs Administrative Codes preferred. Experience reviewing documentation, records, billing, or contracts for accuracy and compliance preferred.  A Valid Wisconsin Driver’s license.

• Knowledge of applicable federal laws, State statutes, Administrative Codes, and program requirements governing Medicaid-funded behavioral health services.

• Ability to review documentation and billing records for accuracy, completeness, and compliance with established policies, procedures, and contractual requirements.

• Demonstrated initiative, attention to detail, and commitment to completing assignments efficiently and accurately while managing multiple projects, deadlines, and priorities.

• Ability to work independently on assigned projects while coordinating activities that cross unit, departmental, and agency lines.

• Ability to exercise sound judgment and professionalism when addressing errors, discrepancies, or compliance concerns, including in potentially stressful or confrontational situations.

• Effective verbal and written communication skills, including the ability to clearly explain findings, ask clarifying questions, and document review results.

• Ability to establish and maintain effective working relationships with coworkers, supervisors, contracted providers, community partners, and members of the public.

• Ability to follow instructions, complete assigned tasks, and work closely with supervisory staff and team members.

• Working knowledge of confidentiality requirements and the ability to appropriately safeguard sensitive and protected information.

• Strong organizational skills, including the ability to maintain accurate records, supporting documentation, and audit materials.

• Ability to use computer systems and office software to support documentation review, reporting, communication, and tracking activities.

• Willingness to participate in training, meetings, and professional development activities to maintain knowledge of program requirements and quality assurance processes.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties and responsibilities of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Work is performed primarily in an office environment within Health and Human Services, with regular interaction with department staff, contracted providers, fiscal staff, and community partners.

• Minimal physical exertion is required; occasional lifting, carrying, or moving of files, boxes, or materials weighing up to approximately 25 pounds may occur.

• Duties require extended periods of sitting, standing, and walking; frequent use of a computer, keyboard, telephone, and standard office equipment; and repetitive hand and finger movements related to data entry, document review, and report preparation.

• The position requires the ability to read, review, and analyze detailed written and electronic records; sufficient vision to view computer screens and printed materials is required.

• Requires the ability to hear and understand verbal communications in person and by telephone.

• Requires the ability to speak clearly and effectively to communicate information.

• The position involves sustained concentration, attention to detail, and accuracy while reviewing documentation and financial records, often under time-sensitive conditions.

• Work may include frequent deadlines, interruptions, and competing priorities, requiring the ability to manage stress and maintain accuracy.

• Regular exposure to confidential, sensitive, and legally protected information is inherent to the position and requires strict adherence to confidentiality and data security standards.

• Occasional meetings, trainings, or collaborative activities may occur outside the immediate work area, including participation in regional or statewide meetings related to Medicaid, behavioral health, or fiscal processes.

• Risk of blood-borne pathogen exposure is considered low.