Medical Assistance Specialist ; NY HELPS

The MAS1 incumbent will supervise a team of subordinate staff in the Bureau of Program Compliance and Audit (BPCA) within the Division of Eligibility and Marketplace Integration (DEMI) and will assist higher level staff with primary BPCA functions. Duties may include, but are not limited to:

• Monitoring the status of all audits and reviews involving DEMI program areas, including ones conducted by the Office of State Comptroller (OSC), the Office of the Inspector General (OIG) and the federally mandated Payment Error Rate Measurement (PERM) audit.
• Liaising with appropriate State and Federal contacts to ensure adequate DEMI attendance at all audit related meetings/conferences. Coordinating DEMI responses to preliminary, draft, and final findings/reports, follow-up questions, and requests for status updates.
• Reviewing eligibility findings involving NY State of Health (NYSOH) to determine if DEMI agrees with audit conclusions. Coordinating with appropriate program staff to ensure that all other cases are reviewed and evaluated in a consistent manner. Reviews will include ensuring financial eligibility criteria was met when reviewing eligibility determinations for NYSOH programs and performing quality assurance activities of eligibility determinations to ensure compliance with laws, rules, regulations, and policies.
• Assisting with supervising and coordinating logistics for onsite fieldwork, as needed. This may include systems access, trainings and workspace.
• Providing direct and indirect supervision of subordinate staff, including determining criteria for unit performance, training, performance evaluations and counseling.

• 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 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.

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

The NYS Department of Health is committed to making New York a safer, healthier, and more equitable place to live.…