Medical Assistance Specialist ; NY HELPS

Overview

Duties Description As part of the Bureau of Program Review within the Division of Eligibility and Marketplace Integration, the Medical Assistance Specialist 1 (MAS
1) will conduct Medicaid and Child Health Plus (CHPlus) pre- and post-eligibility reviews for:
Child Health Plus Health Plan Reviews, Local District Monitoring Reviews, Public Health Emergency Unwind and Special Reviews and/or Medicaid Eligibility Quality Control Reviews, to evaluate and monitor health plan, local district and/or other State agency compliance with State and federal Medicaid rules involving recipient eligibility and enrollment processes, using eligibility policies, evaluation standards and applicable data systems and other resources.

• Perform reviews, write up findings and assign finding codes for all cases, and complete quality control reviews on initial and peer worksheets completed by subordinate staff.
• Assist in testing, updating and revising standardized review worksheets and training materials.
• Conduct case research and identify cases at risk for irregularities.
• Generate test and/or review samples.
• Perform data analysis and accumulate review results.
• Draft and edit summary reports.
• Provide supervision to professional subordinate staff, coordinate staff assignments, and review, monitor and evaluate staff performance.

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

• Professional experience in public health insurance programs, including New York’s Medicaid and/or Medicare.
• Excellent verbal and written communication skills; strong analytical skills and attention to detail; strong organizational skills.
• Proficiency in Microsoft Office (Word, Excel, Access); ability to work independently and as part of a team; ability to manage multiple priorities to meet deadlines.
• Experience using electronic data systems, such as eMedNY and NYSOH Back Office. Supervisory experience is a plus.

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...

Other The NYS Department of Health is committed to making…