Review Vacancy
TitleHealth Systems Specialist 3
Occupational CategoryHealth Care, Human/Social Services
Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)
Salary RangeFrom $71847 to $90876 Annually
Street Address Office of Health Insurance Programs, Division of Operations & Systems
Bureau of Medical Review, Riverview Center
Minimum Qualifications Current Department of Health employee with permanent or contingent-permanent competitive service as a Health Systems Specialist 3, G-23 OR current Department of Health or other New York State employee with one year of permanent or contingent-permanent competitive service in a qualified title, G-21 or higher, and deemed eligible to transfer to Health Systems Specialist 3 under Section 70.1 of Civil Service Law.
Preferred Qualifications:
Solid knowledge of Medicaid regulations, statute, payment rules and policy with
extensive experience supervising and conducting medical post payment claims adjudication.
Duties Description The incumbent of this position will manage a team of administrative and professional staff performing adjudication of medical pended claims or prior approvals; establish and enforce performance and production standards; review, monitor and evaluate staff and work products; provide training; perform complex claims adjudication; review regulatory appeal and waiver requests; maintain and update instruction and guidance documents; provide verbal and written communication to providers and other stakeholders, including statistical and analytical reporting to management. The Health Systems Specialist 3 may participate in design and implementation of system projects and perform editing and criteria setting within the claims processing system. The incumbent must be familiar with and able to interpret Medicaid regulations, statute, payment rules and policy determinations and translate into systems and operational protocols to ensure claims payment reflects current Medicaid guidelines. Additionally, the Health System Specialist 3 may respond to requests for programmatic information, assist with research and resolution of audit findings, and assist with preparations for litigation and fair hearings.
Additional Comments Permanent, Full-time
Some positions may require additional credentials or a background check to verify your identity.
Name Human Resources Management Group - WN/HSS3/90654
Email Address personnel@health.ny.gov
Address
Street Room 2217 Corning Tower, Empire State Plaza
Notes on ApplyingSubmit resume, preferably in PDF format, to Human Resources Management Group, WN/HSS3/90654, Room 2217, Corning Tower Building, Empire State Plaza, Albany, New York 12237- 0012, or fax to (518) 473-3395, or by email to resume@health.ny.gov, with Reference Code WN/HSS3/90654 included in the subject line. Failure to include the required information in the subject line of your email or fax may result in your resume not being considered for this position. Resumes will be accepted until December 1, 2017.