Medicaid Eligibility Examiner 1
Open to the public.
|Agency||New York State Department of Health|
|Title||Medicaid Eligibility Examiner 1|
|Salary||$32,653 - $40,136|
|Salary Grade||Grade 9|
|Negotiating Unit||CSEA - Administrative Services Unit (02)|
|Location||OHIP - Division of Health Reform & Health Insurance Exchange Integration, Albany, NY 12237|
|Minimum Qualifications||Two years of professional experience performing one or more of the following six activities* in a program that: reimburses for health care svcs; provides health care svcs directly; provides health care regulatory oversight; or performs quality assurance and interpretation/application of standards of health care. *Activities: 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; 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; administering or supervising day-to-day program operations with ongoing responsibility for budgeting, staffing, planning, or 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 evaluation 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 evaluation contracts; Substitution: College study may be substituted for up to one year of the required general experience, at the rate of 15 semester credit hours equaling six months of the required experience.|
|Preferred Qualifications||Expertise with New York's Medicaid, CHPlus, and FH Plus eligibility and coverage policy issues; experience with Medicaid policy and procedures related to the Medicare Savings Program, Family Planning Benefit Program and Third Party Health Insurance; expertise in public health insurance programs; especially with eligibility and coverage policy issues; ability to function independently and as part of a team; and ability to work well under pressure and meet deadlines.|
|Responsibilities||Assist in developing operational procedures related to centralizing Medicaid eligibility and renewal activities; reviewing documentation concerning original and continued eligibility applications; receiving applications either electronically, by mail, telephone or in person for public health insurance and obtains additional information omitted by applicant; determining the need for further fact-finding to avoid monetary loss to the Department and Medicaid Program; issuing a client notice explaining the eligibility determinations; reviewing cases to ensure that eligibility was determined correctly; 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; preparing formal communication regarding program administration; working collaboratively with other DOH program areas to identify and discuss administrative changes, recommendations and suggestions to improve operations and solve problems; identifying the program the applicant is eligible for i.e. Medicaid, Child Health Plus, Family Health Plus, etc.; and researching applicant status, prior history and payment history, utilizing various data storage and retrieval systems.|
|Conditions of Employment||Provisional appointment pending examination, full-time.|
|Application Procedure||Submit resume to Human Resources Management Group, MEE1/Various/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 MEE1/Various/RD.|
|Submit resumes by||Until positions are filled|
An affirmative action/equal opportunity employer. Women, minorities and people with disabilities are encouraged to apply.
|Issued||December 14, 2012|