Medical Assistance Specialist ; NY HELPS

Position: Medical Assistance Specialist 1 (NY HELPS) - 79638
Duties Description The Medical Assistance Specialist 1 will work within the Eligibility Systems Modernization Group (ESMG) as part of a team responsible for implementing the Medicaid policy/legislative changes to the Rest of State (ROS) Welfare Management System (WMS); assisting in the development and testing of the Medicaid Eligibility and Client Management (MECM) system; executing User Acceptance Testing(UAT) for policy/legislative changes to NYSOH;

the transition of populations out of WMS into NYSOH and MECM; provide project support where changes to NYSOH, eMedNY, and the MECM impact WMS interfaces;
Production support including file transfers, Help Desk, defect analysis and remediation for MECM and ROS WMS; and the support of continuous improvement activities required to reduce risk and minimize the negative consequences of implementing business systems change.

The incumbent will be primarily responsible for work efforts for the Bureau of Upstate Eligibility Systems (UES) as part of the Testing team related to the implementation of rule changes including, but not limited to:
Participates in development activities with staff and contractors, including meeting with stakeholders, to track system behavior and documentation. Drafts, reviews, and updates training and guidance documents, manuals, and job aids.
Writes procedure manuals and documents process.
Reviews system change requests to ensure systems adhere to applicable Program policies.
Collaborate with other departments and stakeholders to review system change documentation.
Develops test data and scenarios, tests systems functions in UAT, and documents the results.

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:

Experience with NYS Health Insurance Programs (Medicaid, CHP, EP, APTC) eligibility requirements. Experience using eMedNY, NYSOH, WMS, MECM systems. Experience in user acceptance testing. Experience in project management. Good attention to detail, excellent verbal and written communication skills.

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

• Access to NY 529 and NY ABLE College Savings Programs,…