Medicaid Eligibility Examiner 2
Open to the public.
| Agency | New York State Department of Health |
|---|---|
| Title | Medicaid Eligibility Examiner 2 |
| Salary | 43,270 - $52,552 |
| Salary Grade | Grade 14 |
| Negotiating Unit | CSEA - Administrative Services Unit (02) |
| Location | OHIP - Division of Health Reform & Health Insurance Exchange Integration, Albany, NY 12237 |
| Minimum Qualifications | Four 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; works with social services program areas; determines eligibility for a consumer assisted program; 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; determining eligibility for a consumer assisted program in which financial eligibility criteria must be met; 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 two year of the required general experience, at the rate of 30 semester credit hours equaling one year 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; planning and conducting staff training in response to identified needs or when new or revised regulations and procedures are introduced; providing written material, orally explaining and answering questions; scheduling work and work stations, monitoring workload volumes, and reassigning staff to ensure timely determination of new or continued eligibility as well as equitable work distribution; monitoring the quantity and quality of work completed by staff to ensure accuracy and adherence to procedures and instructions; identifying and resolving inaccuracies; mediating with irate applicants and responding to inquiries for information about applicable laws, rules and regulations; addressing specific concerns for resolution of more complex applications; preparing written correspondence in response to questions from consumers, legislative staff and other interested parties; drafting papers to explain problems or deficiencies and solutions needed for more complex applications to managers of the programs; preparing, compiling and organizing data for various operating and management reports; may appear at judicial or administrative proceedings when required to interpret decision; developing and reviewing eligibility scenarios to test new computer applications and systems; 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; reviewing information and identifying inconsistencies to determine whether additional review is necessary; 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, MEE2/Various/RD, Room 2217, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012, or by e-mail to resume@health.state.ny.us or by fax to (518) 473-3395. Please use a subject line of MEE2/Various/RD. |
| Submit resumes by | Application Date Closed |
An affirmative action/equal opportunity employer. Women, minorities and people with disabilities are encouraged to apply.
| Item # | MEE2 Various |
|---|---|
| Issued | December 14, 2012 |
