Medicaid Eligibility Examiner 1
Open to the public.
|Agency||New York State Department of Health|
|Title||Medicaid Eligibility Examiner 1|
|Salary Grade||Grade 9|
|Location||Division of Legal Affairs, NY State of Health Counsel, Bureau of Appeals, Corporate Woods, Albany, New York|
|Minimum Qualifications||" Two years of professional experience performing one or more of the following six activities*, in a program that: " Reimburses for health care services; " Provides health care services directly; " Provides health care regulatory oversight; or " Performs quality assurance and interpretation/application of standards of health care. *Activities: 1. Determining eligibility for a health care program in which financial eligibility criteria must be met; 2. 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; 3. Developing mechanisms for the reimbursement and financing of health care services, including rate-setting or approval, capitation reimbursement methodologies, fee schedule development, coding constructs for medical goods and services, or application/processing or reimbursement methodologies; 4. Administering or supervising day-to-day program operations with ongoing responsibility for budgeting, staffing, planning, or ensuring compliance with laws, rules, regulations, and policies; 5. Inspecting, assessing, or monitoring health care programs or facilities for certification, licensure or adherence to laws, rules, regulations, and policies; and 6. Planning, designing, developing, researching, or evaluating proposals to establish or refine programs, with ongoing responsibility for interpreting legislation or regulations, defining/describing target populations and local demographics, grant/proposal writing, or developing, reviewing, and evaluating contracts.|
|Responsibilities||Within the Division of Legal Affairs, NY State of Health Counsel, Bureau of Appeals, the incumbents of these positions will provide support activities related to appeals from eligibility determinations made by the NY State of Health, Health Plan Marketplace; assist with the scheduling of hearings and desk reviews; coordinate with the customer service provider regarding the processing of appeals requests; make arrangements for off-site hearings; provide technical assistance on eligibility policy for Medicaid, CHP, advanced premiums tax credits and cost sharing reductions; assist legal staff; and perform functions necessary to assume the responsibilities of the Local Departments of Social Services pertaining to eligibility for health insurance programs and hearings regarding eligibility determinations . Duties include: processing consumer appeals; coordinating with the customer service provider regarding appeals requests; processing requests for reconsiderations and further appeals; preparing, maintaining and distributing appeals files: assisting the legal staff; entering changes into NY-HX to effectuate appeal determinations; uploading decisions to the HX systems; reviewing cases with respect to status, aid to continue, compliance and related issues; handling additional evidence received at hearings and making sure that evidence is properly stored; resolving discrepancies in various data match processes; ensuring systems are operated in a manner consistent with federal and state statute and regulations; assisting in the implementation of policy and regulation changes; working collaboratively with other DOH program areas to identify and discuss administrative changes, recommendations and suggestions to improve operations and solve problems; and researching applicant status, prior history, the status of appeals requests; and payment history, utilizing various data storage and retrieval systems.|
|Conditions of Employment||Provisional pending exam, full-time.|
|Application Procedure||Submit resume to Human Resources Management Group, MEE1Open/15265/RD, Room 2217, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012, or by e-mail to firstname.lastname@example.org or by fax to (518) 473-3395. Please use a subject line of MEE1Open/15265/RD.|
|Submit resumes by||Until position is filled|
An affirmative action/equal opportunity employer. Women, minorities and people with disabilities are encouraged to apply.
|Item #||15265-15267 Open|