Program Research Specialist ; Health Care Finance); NY HELPS

In the Office of Health Insurance Program's Division of Health Plan Contracting and Oversight within the Bureau of Managed Care Fiscal Oversight, the Program Research Specialist 2 (HCF)'s responsibilities include:

In the Office of Health Insurance Program's Division of Health Plan Contracting and Oversight within the Bureau of Managed Care Fiscal Oversight, the Program Research Specialist 2 (HCF)'s responsibilities include:

Overseeing timely filing and accuracy of the quarterly and annual financial reporting for managed care plans, including Medicaid Managed Care Operating Reports (MMCORs), Medical Loss Ratio (MLR), Annual Certified Audited Financial Statements and NYS Escrow Fund bank statements submitted by managed care plans.

Monitoring the financial condition and solvency of managed care plans, including analysis of their financial operations and compliance with financial reporting such as the NYS Escrow Fund, Contingent Reserve and Net Worth requirements for compliance with Public Health Law, regulations and policies.

Review and evaluate equity transfers, such as dividend requests, asset transfers and surplus note repayments.

Maintain access to the Health Commerce System (HCS) MMCOR application access for managed care plans.

Communicate report findings and work with managed care plans to improve compliance in all areas of fiscal reporting and data submission.

Current New York State Department of Health employee with permanent or contingent permanent status as a Program Research Specialist 2 Health Care Finance (HCF), SG-23, OR;
Current New York State employee with one year or more of permanent or contingent-permanent, competitive service in a title at or above SG-21, and eligible to transfer under Section 52.6 of the Civil Service Law to Program Research Specialist 2 Health Care Finance (HCF), SG-23.

Non-Competitive Candidates via NY HELPS Program: A bachelor's degree including or supplemented by NINE semester credit hours in statistics, biostatistics, economics, econometrics, research methods, mathematics, data analysis, or data modeling PLUS THREE YEARS of professional
* research experience in the collection and evaluation of quantitative data directed toward review and analysis of healthcare reimbursement mechanisms, funding methodology, health economics, healthcare financing, cost containment, or patient classification systems.

Substitution: J.D. or master's degree may substitute for one year of the experience; a doctoral degree may substitute for two years of the experience.

Preferred Qualifications:

Critical thinking skills and analytical skills, ability to solve problems independently. Professional work experience and/or education in healthcare and trend analyses.

When reviewing qualifications, omissions and vagueness cannot be interpreted in the candidate’s favor. Candidates are responsible for providing accurate and clear descriptions of their experience demonstrating how they meet the minimum qualifications.

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

This position may require travel throughout New York State including overnights to areas not served by public transportation.

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...

The NYS Department of…