Medicaid Eligibility Examiner 2 (NY HELPS) - 15228, 15243, 15445, 79193, 79228, 79696
: Job Details :

Duties Description The Bureau of Program Compliance and Audit (BPCA) interacts with external auditors such as Office of State Comptroller (OSC), Office of Inspector General (OIG), and the Center for Medicare and Medicaid Services (CMS) to ensure that local district and the New York State of Health eligibility determinations are in compliance with State and Federal eligibility rules and regulations. The primary responsibilities of an MEE2 in BPCA include:•Conduct initial and peer post-eligibility reviews, designed to evaluate the appropriateness of recipient eligibility determinations and/or whether enrollment processes were properly executed. •Analyzing data and/or conduct case-specific research to identify cases for possible follow-up action because they appear to be at risk for irregularities or vulnerabilities, as needed.•Conduct pre-review planning and preparation activities. Perform research and/or analysis in accordance with policies and procedures.•Assist supervisors and superiors in tallying and aggregating review results, as well as editing summary reports, when necessary.•Work with auditors in getting the proper access to the various systems and possibly answer questions received from the auditors.Minimum Qualifications Permanent: Current NYS employee with one year or more of permanent or contingent-permanent, competitive service as a Medicaid Eligibility Examiner 2 (G14), OR a NYS employee with one year or more of permanent or contingent-permanent, competitive service in a position allocated to a salary grade 12 above and eligible for transfer under Section 70.1 of the Civil Service Law.If three or fewer New York State Department of Health promotional candidates respond to this notice, the agency may, at its discretion, nominate a qualified employee for non-competitive promotion under the provisions of Section 52.7 of the Civil Service Law.Provisional: Current Department of Health employee with one year of permanent or contingent-permanent, competitive service as a Medicaid Eligibility Examiner 1 or Medicaid Eligibility Examiner 1.NON-COMPETITIVE MINIMUM QUALIFICATIONS:Four years of full-time experience performing one or more of the following six activities, in a program with one or more of the following functions: reimburses for health care services; works with social services program areas; determines eligibility for a consumer assisted program in a hospital or other health care facility; provides health care regulatory oversight; or performs quality assurance and interpretation/application of standards of health care. Activities include: determining eligibility for a health care program in which financial eligibility criteria must be met; performing utilization review, including pre-payment or post-payment review of requested health care services, prior approval or authorization activities, adjudication or pricing of claims for payment; or analysis of patterns of health care; determining reimbursement and financing of health care services, including rate-setting or approval, establishing capitation reimbursement methodologies, assessing fee schedules, coding constructs for medical goods and services, or applying/processing of reimbursement methodologies; performing quality assurance activities such as ensuring compliance with laws, rules, regulations, and policies; inspecting, assessing, or monitoring health care programs or facilities for certification, licensure, or adherence to laws, rules, regulations, and policies; planning, designing, developing, researching, or evaluating proposals to establish or refine programs, with ongoing responsibility for interpreting legislation or regulations, defining and describing target populations and local demographics, grant and proposal writing, or developing, reviewing, and evaluating contracts.College credit hours may substitute for up to two years of experience at the rate of 30 college credits equaling one year of experience.Preferred Qualifications: Preferred candidates will have professional experience in public health insurance programs, including New York's Medicaid and/or Medicare. Preferred candidates will also have excellent verbal and written communication skills; strong analytical skills and attention to detail; strong organizational skills; proficiency in Microsoft Office (Word, Excel, Access); the ability to work well independently and as part of a team, and to manage multiple priorities in order to meet deadlines; and experience using electronic data systems, such as eMedNY and NYSOH Back Office. Supervisory experience is a plus.Additional Comments This position is part of the NYS HELPS program. No examination is required. We offer a work-life balance and a generous benefits package, worth 65% of salary, including:•Holiday & Paid Time Off•Public Service Loan Forgiveness (PSLF)•Pension from New York State Employees' Retirement System •Shift & Geographic pay differentials •Affordable Health Care options•Family dental and vision benefits at no additional cost •NYS Deferred Compensation plan•Access to NY 529 and NY ABLE College Savings Programs, and U.S. Savings Bonds•And many more...For new State employees appointed to graded positions, the annual salary is the hiring rate (beginning of the Salary Range) of the position. Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations and negotiated union contracts. The NYS Department of Health is committed to making New York a safer, healthier, and more equitable place to live. Understanding health equity, social determinants of health and health disparities is critical to accomplish our goal of eliminating health disparities. For more information on the NYS Department of Health's Mission, Vision, Values and Strategic Plan, please visit: Some positions may require additional credentials or a background check to verify your identity.Name Human Resources Management Group, EW/MEE2/MULTI Telephone 518-###-#### Fax (518) ###-#### Email Address ...@health.ny.gov AddressStreet Room 2217, Corning Tower Empire State Plaza City Albany State NY Zip Code 12237 Notes on Applying Please submit your resume and cover letter as one (1) document, preferably in PDF format, by email to ...@health.ny.gov, with Reference EW/MEE2/MULTI included in the subject line or by mail to Human Resources Management Group, EW/MEE2/MULTI, Rm 2217, Corning Tower Building, Empire State Plaza, Albany, NY 12237-0012, or by fax to (518) ###-####. Failure to include the required information may result in your resume not being considered for this position.