Review Vacancy
TitleMedicaid Eligibility Examiner 2 (NY HELPS) - 79193
Occupational CategoryOther Professional Careers
Bargaining UnitASU - Administrative Services Unit (CSEA)
Salary RangeFrom $56506 to $68630 Annually
Appointment Type Contingent Permanent
Street Address Office of Health Insurance Programs/ Division of Eligibility and Marketplace Integration/ Bureau of Program Compliance and Audit
99 Washington Avenue, One Commerce Plaza
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 New York State employee with one year or more of permanent or contingent-permanent, competitive service as a Medicaid Eligibility Examiner 2 , SG-14, OR a New York State employee with one year or more of permanent or contingent-permanent, competitive service in a position allocated to SG-12 above and eligible for transfer under Section 70.1 of the Civil Service Law.
Provisional Appointment: In the absence of an eligible list with three or more candidates willing to accept a position, a temporary provisional appointment may be considered. For provisional appointment, candidates must meet one of the following minimum qualifications: Current New York State 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 SL.
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.
Non-Competitive Candidates via NY HELPS Program:
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.
*Substitution: 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.
This position may require travel throughout New York State including overnights to areas not served by public transportation.
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...
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: https://health.ny.gov/commissioner/index.htm
If you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone 518-486-1812 or email doh.sm.reasonable.accommodation@health.ny.gov to make a request.
NYS Department of Health does not participate in E-Verify and does not sponsor visa applications.
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.
Some positions may require additional credentials or a background check to verify your identity.
Name Human Resources Management Group
Email Address resume@health.ny.gov
Address
Street Corning Tower, Empire State Plaza, Room 2217
Notes on ApplyingPlease submit your resume and cover letter as one (1) document, preferably in PDF format, by email to resume@health.ny.gov, with Reference CD/MEE2/79193 included in the subject line or by mail to Human Resources Management Group, CD/MEE2/79193, Rm 2217, Corning Tower Building, Empire State Plaza, Albany, NY 12237-0012, or by fax to (518) 473-3395. Failure to include the required information may result in your resume not being considered for this position.