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295 Main Street Suite 814
Minimum Qualifications Provisional Promotion Candidates: Current Department of Health employee with one year or more permanent or contingent-permanent competitive or 55-b/55-c service in the Medicaid Eligibility Examiner 2 title.
Provisional Open Competitive Candidates: Five (5) years of professional experience [one (1) year of which must have included supervision of staff] performing one or more of the following six activities*, in a program that: reimburses for health care services; works with social service program areas; determines eligibility for a consumer assisted program; provides health care services; provides health care regulatory oversight; or performs quality assurance and interpretation/application of standards of health care.
1. Determining eligibility for a health care program in which financial eligibility criteria must be met.
2. 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.
3. 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 application/processing of reimbursement methodologies.
4. Performing quality assurance activities such as ensuring compliance with laws, rules, regulations, and policies.
5. Inspecting, assessing, or monitoring health care programs or facilities for certification, licensure, or adherence to laws, rules, regulations, and policies.
6. 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.
NOTE: College study may be substituted for up to two (2) years of the required general experience, at the rate of 30 semester credit hours equaling one (1) year of the required experience. The remaining three (3) years of experience must have included one (1) year of supervision of staff.
Knowledge of the eligibility requirements for New York’s public health insurance programs; strong written and verbal communication, interpersonal and organizational skills; experience prioritizing work activities and goals; ability to research and analyze information; ability to function independently and as part of a team; and the ability to work well under pressure and meet deadlines.
Duties Description The incumbent will assist with call center referrals/complaints processing and conducting an assigned number of Quality Assurance reviews each month, typically in more than one QA area (telephone support, paper applications, document processing, web chat). This position will attend internal and external QA meetings and may participate in some or all of the following activities: live monitoring of contractor telephone representatives, preparing QA reports, reviewing meeting minutes or other written material, maintaining spreadsheets and logs of QA procedures, work instructions, concerns, errors, etc. Staff may also assist with monitoring contractor training sessions. In addition, the Medicaid Eligibility Examiner 3 will supervise subordinate staff.
Some positions may require additional credentials or a background check to verify your identity.
Notes on ApplyingSubmit resume, preferably in PDF format, to Human Resources Management Group, SP/MEE3/79349, Room 2217, Corning Tower Building, Empire State Plaza, Albany, New York 12237- 0012, or by fax to (518) 473-3395, or by email to email@example.com with Reference Code SP/MEE3/79349 included in the subject line. *Failure to include the required information in the subject line of your email or fax may result in your resume not being considered for this position. Resumes accepted until June 18, 2018.