NY HELPNo

AgencyHealth, Department of

TitleHearing Officer 3

Occupational CategoryLegal

Salary Grade663

Bargaining UnitM/C - Managerial/Confidential (Unrepresented)

Salary RangeFrom $115283 to $145682 Annually

Employment Type Full-Time

Appointment Type Contingent 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 New York

Street Address NYSOH Appeals

Corporate Woods

City Albany

StateNY

Zip Code12211

Duties Description Working as an Appeals Manager for the NY State of Health, the official Health Plan Marketplace (the “Marketplace”) the incumbent of this position will be responsible for managing appeals processes for the new MECM System [Medicaid Enterprise Client Management] which includes eligibility in Non-MAGI Medicaid programs (e.g. SSI Eligible Individuals, 65 years or older, Foster Care/Adoption Assistance Disabled with Medicare, Blind with Medicare, Home and community-based waiver support, Long Term Care Beneficiaries, Medicare Savings Program Recipients, AIDS Insurance Qualified, Qualified Disabled and Working Individuals, Medicaid Buy-In Program and Special Needs Trusts) as well as issues involving Medicaid eligibility in the existing Marketplace system.
The incumbent of this position will supervise Hearing Officer 2s and ensure that timely appeals hearings and decisions are available to individuals receiving eligibility determinations. The incumbent will also provide guidance on Customer Service procedures for receiving and processing individual requests for appeal. Such duties shall include but not be limited to:
• Oversee MECM (Non-MAGI) appeals program by supervising staff, acquiring resources and ensuring that regulatory timeframes and production standards are met.
• Review hearing decisions to ensure that law, policies and procedures are being correctly applied.
• Review and take final action regarding recommendations on requests for reconsideration of hearing decisions to ensure that decisions are correctly decided; and amend or reopen hearing records as appropriate.
• Review pertinent court rulings and determine their effect on hearing policies and procedures. Assist in modifying policies and procedures to comply with court decisions, statutory amendments and regulatory changes.
• Assist in identifying training needs for hearing officers and support staff and supporting a training program to prepare hearing officers to conduct hearings regarding the programs available in the MECM system; approve updates to the training program as necessary.
• Review and comment on proposed legislation affecting the hearing program.
• Assist in responding to claims of non-compliance with hearing decisions and ensure proper resolution of complaints.
• Assist with the external program integrity audit of the Marketplace appeals program and audits by State and federal agencies regarding the appeals program and/or the individual insurance programs available through the Marketplace.
• Maintain data on an ongoing basis regarding the appeals program, including appeal requests, hearings, and the status of individual appeals.
• Assist in fielding inquiries and addressing complaints from appellants, representatives, or other governmental agencies concerning the hearing process.
• Assist in the review of hearing decisions that are appealed to the courts, assist in preparing the defense of Article 78 litigation involving hearing decisions.
• Provide expert legal advice and opinions to management and staff on hearing matters and customer service staff regarding the appeal process.
• Draft reports on hearing activities. Prepare or assist in compiling the budget for the hearings operation.
• Represent the agency in meetings with legal advocacy and other interest groups; and provide information concerning the operation and practices of the appeals program.
• Serve as a point of contact for the appeals program on inter-agency projects involving IT systems or other agency initiatives.

Minimum Qualifications Permanent Transfer: Current NYS Department of Health employee with permanent or contingent-permanent, competitive status as a Hearing Officer 3, G-29 or M-3 OR a NYS employee with one year or more of permanent or contingent-permanent, competitive service in a title at or above a G-27 or M-2 and deemed eligible for transfer to a Hearing Officer 3, M-3 under Section 52.6 of the NYS Civil Service Law.

Promotional Provisional: Current NYS Department of Health employee with one year or more of permanent or contingent-permanent competitive service as a Hearing Officer 2. *If appointed provisionally, the incumbent will need to take the next Civil Service examination for this title and pass with a score that will be immediately reachable on the resulting eligible list to maintain employment.

If three or fewer New York State Department of Health promotional candidates respond to this notice, the agency may, at its discretion, nominate a qualified employee for noncompetitive promotion under the provisions of Section 52.7 of
the Civil Service Law.

NOTE: Admission to the New York State Bar and current registration to practice law in New York State is required for continued employment. Disbarment or loss of registration shall result in termination or suspension of employment.

Preferred Qualifications: Experience with MAGI and Non-MAGI Medicaid; Experience with creating trainings and/or manuals; Willingness to work with others to help create policy and procedures.

Additional Comments 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

If you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone 518-486-1812 or email doh.sm.reasonable.accommodation@health.ny.gov to make a request.

NYS Department of Health does not participate in E-Verify and does not sponsor visa applications.

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.

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

Name Human Resources Management Group

Telephone 518-486-1812

Fax 518-473-3395

Email Address resume@health.ny.gov

Address

Street Corning Tower, Empire State Plaza, Room 2217

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/HO3 included in the subject line or by mail to Human Resources Management Group, EM/HO3, 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.