Position Information

NY HELPYes

AgencyHealth, Department of

TitleEligibility Program Manager 1 (NY HELPS) - 79434

Occupational CategoryOther Professional Careers

Salary Grade27

Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)

Salary RangeFrom $103784 to $127830 Annually

Employment Type Full-Time

Appointment Type Permanent

Jurisdictional Class Competitive Class

Travel Percentage 0%

Schedule

Workweek Mon-Fri

Hours Per Week 37.5

Workday

From 9 AM

To 5 PM

Flextime allowed? No

Mandatory overtime? No

Compressed workweek allowed? No

Telecommuting allowed? Yes

Location

County Albany

Street Address Division of Eligibility and Marketplace Integration / Bureau of Program Review

99 Washington Avenue, One Commerce Plaza

City Albany

StateNY

Zip Code12210

Job Specifics

Minimum Qualifications Competitive Minimum Qualifications:
New York State employee with one or more years of permanent or contingent-permanent service in title at Grade 25 or above, and eligible for transfer to EPM 1, G27, under Section 70.4, 70.1 or 52.6 of the Civil Service Law.

This title is part of the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS). HELPS Program titles may be filled via a noncompetitive
appointment. This means that you do not need to take an exam to qualify, but you do need to meet the minimum qualifications of the title.


If you are hired via HELPS, at a future date (within one year of permanent appointment), employees hired under NY HELPS are expected to have their permanent non-competitive
employment status converted to permanent competitive status. You will not have to take an exam to gain permanent competitive status.

Non - Competitive Minimum Qualifications:
Eight years of professional experience, two years of which must have included second-level supervision of staff, performing one or more of the following seven activities in a program with one or more of the following functions: provides reimbursements 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
1. Overseeing and directing staff in determining eligibility for a health insurance program or consumer assisted program in which financial eligibility criteria must be met.
2. Overseeing and directing staff in performing utilization review, including prepayment 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. Overseeing and directing staff in 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 and processing of reimbursement methodologies.
4. Administering and overseeing staff responsible for day to day program operations for budgeting, staffing, or program planning.
5. Overseeing and directing staff in inspecting, assessing, or monitoring health insurance programs or health care facilities for certification, licensure, or adherence to laws, rules, regulations, and policies.
6. Overseeing and directing staff in planning, designing, developing, researching, or evaluating proposals to establish or refine health related programs, with responsibility for interpreting legislation or regulations, defining and describing target populations and local demographics, grant and proposal writing, or developing, reviewing, and evaluating contracts.
7. Administering and overseeing staff responsible for performing quality assurance activities such as ensuring compliance with laws, rules, regulations, and policies, as it pertains to activities 1 through 6.
A Bachelor's Degree can substitute for four years of experience; a Master's Degree can substitute for five years 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; experience using electronic data systems, such as eMedNY and NYSOH Back Office; and supervisory experience.

Duties Description "Within the Division of Eligibility and Marketplace Integration, Bureau of Program Review, the Eligibility Program Manager 1/G.27 will oversee the Medicaid and Child Health Plus (CHPlus) Units. In this role, the incumbent will develop and update review methodologies and procedures to evaluate and monitor compliance with State and federal rules and regulations regarding recipient eligibility, enrolment processes, and/or payments for CHPlus and Medicaid. The incumbent will also oversee the quality control reviews, as well as the subsequent finding analyses, and reporting to upper-level management and appropriate stakeholders.

Specific duties and responsibilities for this position may include but are not limited to:

• Provide first and second level supervision to professional subordinate staff, coordinate staff assignments, set unit priorities and deadlines, monitor and evaluate staff performance, and resolve issues, as necessary;

• Act as a subject matter expert (SME) in workgroups established to query data systems to develop universes from which sample cases will be drawn. This includes overseeing the query testing process and collaborating with system staff and the Review Planning and Support Unit to ensure correctness;

• Act as a SME in workgroups established to develop trainings and review protocols specific to each review project. This includes designing standardized review worksheets to ensure that reviews are complete and consistent;

• Work with other Department agencies to obtain payment system information for sample cases and determine if the Federal Medical Assistance Percentage (FMAP) was correctly claimed;

• Prepare statistical and/or narrative reports summarizing case review results for management review and approval;

• Draft correspondence to, and liaise with CHPlus health plans, local social service districts and NY State of Health staff concerning their review results; and

• As needed, provide technical assistance to internal review staff, Department management, NY State of Health staff, CHPlus health plans, local social service districts and other State agencies. This includes assisting with root cause analyses and collaborating with program staff about policy decisions to resolve deficiencies and inconsistencies identified during the review process.

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

We offer a work-life balance and a generous benefits package, worth 65% of salary, including:

• Holiday & Paid Time Off
• Public Service Loan Forgiveness (PSLF)
• Pension from New York State Employees’ Retirement System
• Shift & Geographic pay differentials
• Affordable Health Care options
• Family dental and vision benefits at no additional cost
• NYS Deferred Compensation plan
• Access to NY 529 and NY ABLE College Savings Programs, and U.S. Savings Bonds
• And many more...

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.

Contact Information

Name Human Resources Management Group, MVS/EPM1/79434

Telephone 518-486-1812

Fax 518-473-3395

Email Address resume@health.ny.gov

Address

Street Room 2217, Corning Tower Building, Empire State Plaza

City Albany

State NY

Zip Code 12237

 

Notes on ApplyingPlease submit your resume and cover letter as one (1) document, preferably in PDF format, by email to resume@health.ny.gov, with Reference MVS/EPM1/79434 included in the subject line or by mail to Human Resources Management Group, MVS/EMP1/79434, 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.