Medical Assistance Specialist ; NY HELPS

This Medical Assistance Specialist 1 (MAS
1) will work within the Division of Eligibility and Marketplace Integration (DEMI), Bureau of Downstate Eligibility Systems.

Specific duties and responsibilities may include but are not limited to:

Lead or participate in tasks involving requirements gathering, validation of requirements with policy staff, and analysis and provision of business requirements for the new eligibility system to vendors and/or other DOH staff.

Initiate and complete tasks necessary to produce and implement needed system change requests (CRs).

Work with teams of vendors, DOH staff and other stakeholders as needed (e.g. issuers, application assistors) to elicit, document, analyze, resolve issues, and provide technical assistance on implementation of business requirements in one or more of the Units within the Bureau.

Prepare or review training documents and deliver training to small or large groups.

Develop business requirements for legally required consumer notices. Tasks include:

Revising and reviewing notice triggering rules

Writing and revising key messages to communicate legally required information to consumers

Developing message triggering rules based on new and existing system functionality

Providing design input on notices

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 in public health insurance programs, including New York’s Medicaid and/or Child Health Plus

Experience with data systems including, but not limited to, the Welfare Management System (WMS), NY State of Health Back Office and eMedNY;

Ability to research and analyze information

Demonstrated experience in requirements gathering and analysis of policy guidance

Strong, writing, verbal communication, interpersonal, and organization skills and ability to work well under pressure.

Supervisory experience

The candidate must have strong organizational skills and the…