Medicaid Eligibility Examiner 2 (NY HELPS) - 79266, 79082

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Job description

Permanent: Current NYS employee with one year or more of permanent or contingent-permanent, competitive service as a Medicaid Eligibility Examiner 2 (G14), OR a NYS employee with one year or more of permanent or contingent-permanent, competitive service in a position allocated to a salary grade 12 above and eligible for transfer under Section 70.1 of the Civil Service Law.

NON-COMPETITIVE MINIMUM QUALIFICATIONS:
Four years of full-time experience performing one or more of the following six activities, in a program with one or more of the following functions: reimburses for health care services; works with social services program areas; determines eligibility for a consumer assisted program in a hospital or other health care facility; provides health care regulatory oversight; or performs quality assurance and interpretation/application of standards of health care. Activities include: determining eligibility for a health care program in which financial eligibility criteria must be met; performing utilization review, including pre-payment or post-payment review of requested health care services, prior approval or authorization activities, adjudication or pricing of claims for payment; or analysis of patterns of health care; determining reimbursement and financing of health care services, including rate-setting or approval, establishing capitation reimbursement methodologies, assessing fee schedules, coding constructs for medical goods and services, or applying/processing of reimbursement methodologies; performing quality assurance activities such as ensuring compliance with laws, rules, regulations, and policies; inspecting, assessing, or monitoring health care programs or facilities for certification, licensure, or adherence to laws, rules, regulations, and policies; planning, designing, developing, researching, or evaluating proposals to establish or refine programs, with ongoing responsibility for interpreting legislation or regulations, defining and describing target populations and local demographics, grant and proposal writing, or developing, reviewing, and evaluating contracts.

College credit hours may substitute for up to two years of experience at the rate of 30 college credits equaling one year of experience.

Preferred Qualifications: Preferred candidates will have strong analytical skills and the ability to pay attention to details and will also have good oral and written communication skills. Candidates should have proficiency in Microsoft Office (Word, Excel, Access); the ability to work well independently and as part of a team and to manage multiple priorities to meet deadlines. Professional experience in public health insurance programs, including New York's Medicaid, Medicare and/or Child Health Plus and supervisory experience is a plus.

Duties Description The Medicaid Eligibility Examiner 2 (MEE 2) incumbents will work within the Bureau of Third Party Health Insurance, Medicare Savings Program and Recoveries. Duties will include:
• Oversee Third Party Liability (TPL) mailbox. Clearly respond to inquiries in writing and troubleshoot Third Party Health Insurance issues.
• Conduct telephone outreach to consumers and health insurance carriers.
• Complete cost benefit analysis to pay health insurance premiums.
• Create Health Insurance Premium Payments (HIPP) payments.
• Prepare client notices and repayment agreements.
• Manage and complete certain Medicare Buy-in activities for NYC Health Resource Administration.
• Utilize the shared database with CSRA, the State fiscal agent, designed to communicate and triage HIPP payment issues.
• Train and supervise MEE 1/G-9 staff.

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, and U.S. Savings Bonds
• And many more

For new State employees appointed to graded positions, the annual salary is the hiring rate (beginning of the Salary Range) of the position. Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations and negotiated union contracts.

The NYS Department of Health is committed to making New York a safer, healthier, and more equitable place to live. Understanding health equity, social determinants of health and health disparities is critical to accomplish our goal of eliminating health disparities. For more information on the NYS Department of Health's Mission, Vision, Values and Strategic Plan, please visit:

Some positions may require additional credentials or a background check to verify your identity.

Name Human Resources Management Group, EW/MEE2/79082,79266

Telephone

Fax

Email Address

Address

Street Room 2217, Corning Tower

Empire State Plaza

City Albany

State NY

Zip Code 12237

Notes on Applying Please submit your resume and cover letter as one (1) document, preferably in PDF format, by email to , with Reference EW/MEE2/79082,79266 included in the subject line or by mail to Human Resources Management Group, EW/MEE2/79082,79266, Rm 2217, Corning Tower Building, Empire State Plaza, Albany, NY , or by fax to . Failure to include the required information may result in your resume not being considered for this position.

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