Medical Assistance Specialist 1 (NY HELPS) - 79642
: Job Details :

NY HELP YesAgency Health, Department ofTitle Medical Assistance Specialist 1 (NY HELPS) - 79642Occupational Category Other Professional CareersSalary Grade 18Bargaining Unit PS&T - Professional, Scientific, and Technical (PEF)Salary Range From $65001 to $82656 AnnuallyEmployment Type Full-TimeAppointment Type PermanentJurisdictional Class Competitive ClassTravel Percentage 5%Workweek Mon-FriHours Per Week 37.5WorkdayFrom 8 AMTo 4 PMFlextime allowed? NoMandatory overtime? NoCompressed workweek allowed? NoTelecommuting allowed? YesCounty AlbanyStreet Address Division of Health Plan Contracting and Oversight; Managed Care Surveillance99 Washington Avenue, 16th FloorCity AlbanyState NYZip Code 12210Minimum Qualifications Reassignment: Current NYS Department of Health (DOH) employee with permanent or contingent-permanent status as a Medical Assistance Specialist 1, G-18.Transfer: Current NYS employee with one year or more of permanent or contingent-permanent, competitive service in a title eligible to transfer under Section 52.6 or Section 70.1 of the Civil Service Law to a Medical Assistance Specialist 1, G-18.NY HELPS: Six years of experience developing public or private health related policy; analyzing AND interpreting public or private health related policy to assist consumers; determining or reviewing financial eligibility for healthcare or consumer-assisted programs to ensure individuals meet eligibility criteria specified in State and/or federal laws, rules, and regulations; establishing mechanisms for the reimbursement and financing of health care services, including rate-setting, development of capitation reimbursement methodologies, and development of fee schedules; performing utilization review of requests for medical treatment including prior approval or authorization activities, adjudication of claims for payment and/or provider credentialing; AND/OR conducting independent examinations of health care facilities or program integrity reviews of health care programs to ensure compliance with laws, rules, and regulations. Substitution: An associate degree can substitute for two years of specialized experience; a bachelor's degree can substitute for four years of experience; a master's degree in a related field can substitute for five years of experience; and a doctorate in a related field can substitute for six years of experience.Preferred Qualifications: The preferred candidate would have experience with public health insurance programs or health care delivery systems, and knowledge of related compliance activities; Strong public speaking, writing, and problem-solving skills; Ability to work with a diverse group of professionals in a team environment; Excellent organizational skills with the ability to prioritize multiple assignments.Duties Description The position includes but is not limited to the daily activities related to ensuring Managed Care Organizations in New York State are compliant in accordance with State regulations, Public Health statutes, and the Medicaid Contract.The incumbent will:As a survey team member:- Team Member for various disciplines reviewed in the Surveillance of Managed Care Organizations (MCOs)- Travel throughout New York State is required. For assigned plans:- Review written correspondence with MCO's regarding External Quality Review Organization (EQRO) Focus Surveys designed to test and confirm access to care.- Communicate with Managed Care Organization staff and management regarding DOH policy changes, guidance, or other applicable correspondence.- Review Fair Hearing decisions and ensure timely compliance of the Managed Care Organizations. Administration of data, reporting, and policy review:- Assist in developing and reporting data to Bureau Management, CMS, OPQS and KPMG- Participate in ongoing research related to, training, and development of staff training materials. - Assist in the development of surveillance methodology, tools and protocol.- Supervise paraprofessional staff; if needed- Perform Special Projects and other related duties as assigned.Additional Comments This position is part of the NYS HELPS program. No examination is required. This position may require travel throughout New York State including overnights to areas not served by public transportation.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: positions may require additional credentials or a background check to verify your identity.Name Human Resource Management Group, WDW/MAS1/79642Telephone 518-###-####Fax 518-###-####Email Address ...@health.state.ny.usAddressStreet Room 2217, Corning Tower BuildingEmpire State Plaza,City AlbanyState NYZip Code 12237Notes 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 WDW/MAS1/79642 included in the subject line or by mail to Human Resources Management Group, WDW/MAS1/79642, 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.