Medicaid Eligibility Examiner 3

Open to the public.

Agency New York State Department of Health
Title Medicaid Eligibility Examiner 3
Salary $48,518
Salary Grade 17
Negotiating Unit PEF/05
Location NYS Department of Health, Office of Health Insurance Programs Division of Eligibility and Marketplace Integration Albany, New York
Minimum Qualifications Five (5) years of professional experience [one (1) year of which must have included supervision of staff] performing one or more of the following six activities*, in a program that: " Reimburses for health care services; " Works with social services program areas; " Determines eligibility for a consumer assisted program; " Provides health care services; " 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 or consumer assisted 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. NOTE: College study may be substituted for up to two (2) years of the required general experience, at the rate of 30 semester credit hours equaling one (1) year of the required experience. The remaining three (3) years of experience must have included one (1) year of supervision of staff.
Preferred Qualifications
Responsibilities The Division of Eligibility and Marketplace Integration is looking to fill multiple positions that will focus on assuming some of the functions currently performed by the Local Departments of Social Services (LDSS) for the Medicaid program. These positions will help ensure that the process of determining Medicaid, Family Health Plus (FHPlus) and Child Health Plus (CHPlus) eligibility is efficiently and effectively transitioned from the LDSS and the participating CHPlus health plans to a centralized processing unit. Within the Division and under general supervision of higher level staff, the incumbent will serve as supervisor of a small group of paraprofessional and/or support staff that performs a variety of duties related to accepting and processing applications for public health insurance. The incumbents will provide support for activities related to expansion and eligibility initiatives implemented through the Enrollment Center; technical assistance on eligibility policy for Medicaid; and perform functions necessary to assume the responsibilities of the LDSS. Specific duties include but are not limited to: maintain cooperative working relationships with other units, division, departments, and agencies to facilitate the delivery of public health insurance; interpret and communicate a variety of Federal and State laws and codes to implement policies, procedures and maintain compliance in the delivery of public health insurance benefits; review, sign or authorize eligibility determinations; monitor the quantity and quality of work completed by staff to ensure accuracy and adherence to procedures and instructions; identify and resolve inaccuracies; prepare, compile and organize data for various reports; may appear at judicial or administrative proceedings when required to interpret decisions; and develop and review eligibility scenarios to test new computer applications and systems.
Conditions of Employment Provisional pending exam, full-time.
Application Procedure Submit resume to Human Resources Management Group, RD/MEE3/OPEN, Room 2217, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012, or by email to, or by fax to (518)473-3395 with a subject line RD/MEE3/OPEN. Resume must clearly state how you meet the minimum qualifications as stated above. Vague or missing information could result in your being disqualified for consideration for these positions. Applications will be accepted until the positions are filled.
Submit resumes by Until position is filled.

An affirmative action/equal opportunity employer. Women, minorities and people with disabilities are encouraged to apply.

Issued January 31, 2014