Medical Assistance Specialist ; NY HELPS

Position: Medical Assistance Specialist 1 (NY HELPS) - 46281, 79643
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.

Duties will include, but not be limited to:

Performing reviews/writing up findings and assigning finding codes for all cases, completing quality control reviews on initial and peer worksheets completed by subordinate staff.
Assisting in testing, updating and/or revising standardized review worksheets and training materials;
Conducting case research and identifying cases at risk for irregularities;
Generating test and/or review samples;
Performing data analysis and accumulating review results;
Drafting and editing summary reports: and
Providing supervision to professional subordinate staff, coordinating staff assignments, and reviewing, monitoring and evaluating 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:

Preferred candidates will have professional experience in public health insurance programs, including New York's Medicaid and/or Medicare. Preferred candidates will also have excellent verbal and written communication skills; strong analytical skills and attention to detail; strong organizational skills; proficiency in Microsoft Office (Word, Excel, Access); the ability to work well independently and as part of a team, and to manage multiple priorities in order to meet deadlines;

and experience using electronic data systems, such as eMedNY and NYSOH Back Office. Supervisory experience is a plus.

Additional Comments 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

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