NY HELPYes

AgencyHealth, Department of

TitleMedical Assistance Specialist 1 (NY HELPS) - 90803

Occupational CategoryOther Professional Careers

Salary Grade18

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

Salary RangeFrom $65001 to $82656 Annually

Employment Type Full-Time

Appointment Type Permanent

Jurisdictional Class Competitive Class

Travel Percentage 0%

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

County Albany

Street Address OHIP Division of Medical and Dental Directors, Bureau of Medical Review

One Commerce Plaza

City Albany

StateNY

Zip Code12260

Minimum Qualifications Reassignment: Current NYS Department of Health (DOH) employee with permanent or contingent-permanent status as a Medical Assistance Specialist 1, G-18.

Transfer: Current NYS employee with one year or more of permanent or contingent-permanent, competitive service in a title eligible to transfer under Section 52.6 or Section 70.1 of the Civil Service Law to a Medical Assistance Specialist 1, G-18.

NY HELPS: Six years of experience developing public or private health related policy; analyzing AND interpreting public or private health related policy to assist consumers; determining or reviewing financial eligibility for healthcare or consumer-assisted programs to ensure individuals meet eligibility criteria specified in State and/or federal laws, rules, and regulations; establishing mechanisms for the reimbursement and financing of health care services, including rate-setting, development of capitation reimbursement methodologies, and development of fee schedules; performing utilization review of requests for medical treatment including prior approval or authorization activities, adjudication of claims for payment and/or provider credentialing; AND/OR conducting independent examinations of health care facilities or program integrity reviews of health care programs to ensure compliance with laws, rules, and regulations.

Substitution: An associate degree can substitute for two years of specialized experience; a bachelor’s degree can substitute for four years of experience; a master’s degree in a related field can substitute for five years of experience; and a doctorate in a related field can substitute for six years of experience.

Preferred Qualifications: Supervision experience and knowledge of Microsoft Office Suite, Medicaid program, and or eMedNY system preferred.

Duties Description The incumbent will provide supervision to claims review staff within the Pended Claims Unit of the Bureau of Medical Review. Duties include providing guidance to staff on workflow priorities, developing training materials to support new procedures and ensuring staff are trained and competent. The incumbent will perform quality assurance activities, monitor error rates and claim adjudication volumes of staff performance, handle claim reviews and inquiries escalated from unit staff. The incumbent will conduct complex research and verification of claims payment history for providers, communicate orally and in writing with heath care providers and their legal representatives, provide guidance and assistance to staff in the application of department policies, objectives, and priorities regarding review of delayed claims. The incumbent will review and make determinations on requests for payment of high dollar claims pended in eMedNY systems, and additional duties as needed to fulfill the goals of the Bureau.

Additional Comments The Medical Assistance Specialist 1, G-18 position will be assigned to the Medical Pended Claims unit within the Division of Medical and Dental Directors, Bureau of Medical Review. This unit is responsible for review of Medicaid claims pended for timely filing, requests for two-year waiver for claims processing, high-cost outlier claims review, and other claims pended for eMedNY system edits.

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.

Name Human Resource Management Group, EM/90803/MAS1

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 EM/90803/MAS1 included in the subject line or by mail to Human Resources Management Group, EM/90803/MAS1, 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.