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Review Vacancy

Date Posted 01/31/14

Applications Due05/01/14

Vacancy ID12131

AgencyHealth, Department of

TitleMedicaid Eligibility Examiner 2

Occupational CategoryNo Preference

Salary Grade14

Bargaining UnitASU - Administrative Services Unit (CSEA)

Salary RangeFrom $43270 to $43270 Annually

Employment Type Full-Time

Appointment Type Provisional

Jurisdictional Class Competitive Class

Travel Percentage 0%

Workweek Mon-Fri

Hours Per Week 40

Workday

From 8:30 AM

To 4:30 PM

Flextime allowed? No

Mandatory overtime? No

Compressed workweek allowed? No

Telecommuting allowed? No

County Albany

Street Address NYS Department of Health, Office of Health Insurance Programs

Division of Health Reform and Health Insurance Exchange Integration

City Albany

StateNY

Zip Code12239

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;
• 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:
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.

NOTE: College study may be substituted for up to two years of the required general experience, at the rate of 15 semester credit hours equaling six months of the required experience.

Duties Description The Division of Health Reform and Health Insurance Exchange 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 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 and responsibilities include, but are not limited to: Assisting 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 inquires 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.

Additional Comments Provisional pending exam, full-time.

Some positions may require additional credentials or a background check to verify your identity.

Name Human Resources Management Group, RD/MEE2/OPEN

Telephone

Fax (518)473-3395

Email Address resume@health.state.ny.us

Address

Street Room 2217, Corning Tower Building

Empire State Plaza

City Albany

State NY

Zip Code 12237

 

Notes on ApplyingSubmit resume to Human Resources Management Group, RD/MEE2/OPEN, Room 2217, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012, or by email to resume@health.state.ny.us, or by fax to (518)473-3395 with a subject line RD/MEE2/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.

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