MEDICAID ELIGIBILITY EXAMINER 2 (NY HELPS)

Company: StateJobsNY
Location: Buffalo
Posted on: September 22, 2024

Job Description:

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.

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, Medicare and/or Child Health Plus. 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.

Duties Description The Medicaid Eligibility Examiner 2 (MEE 2) will work within the DEMI Bureau of Quality Management and Change Control.

Specific duties may include but are not limited to: providing supervision to lower level staff; fielding electronic referrals from the contact center; working with appropriate staff to resolve consumer issues; identifying and tracking changes to training materials and procedure documents; conducting quality (QA) reviews of work completed by the NY State of Health customer service center contractor using established QA procedures; and maintain cooperative working relationships with other units, division, departments, and agencies to facilitate the delivery of public health insurance.

Additional Comments This position is part of the NYS HELPS program. No examination is required.

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: https://health.ny.gov/commissioner/index.htm

Some positions may require additional credentials or a background check to verify your identity.

Name Human Resources Management Group, MVS/MEE2/79354

Telephone 518-486-1812

Fax (518) 473-3395

Email Address resume@health.ny.gov

Address

Street 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 resume@health.ny.gov, with Reference MVS/MEE2/79354 included in the subject line or by mail to Human Resources Management Group, MVS/MEE2/79354, 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.

Keywords: StateJobsNY, Buffalo , MEDICAID ELIGIBILITY EXAMINER 2 (NY HELPS), Other , Buffalo, New York