StateJobsNY

NY HELPNo

AgencyHealth, Department of

TitleProgram Research Specialist 4 HCF– 87744

Occupational CategoryOther Professional Careers

Salary Grade27

Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)

Salary RangeFrom $95908 to $118129 Annually

Employment Type Full-Time

Appointment Type Permanent

Jurisdictional Class Competitive Class

Travel Percentage 5%

Workweek Mon-Fri

Hours Per Week 37.5

Workday

From 8:30 AM

To 4:30 PM

Flextime allowed? No

Mandatory overtime? No

Compressed workweek allowed? Yes

Telecommuting allowed? Yes

County Albany

Street Address OHIP

99 Washington Ave

City Albany

StateNY

Zip Code12210

Minimum Qualifications Active list candidate on the New York State Department of Civil Service’s Program Research Specialist 4 eligible list #26-095; OR Current Department of Health (DOH) employee with permanent or contingent-permanent status as a Program Research Specialist 4; OR 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 70.4 of the Civil Service Law.


Preferred Qualifications:
Strong attention to details; Experience in the field of Health Care Finances, Proficiency with Standard Query Language (SQL) and SAS data analysis software; Experience querying Medicaid Data Warehouse and/or OHIP Datamart. Strong written and verbal communication, interpersonal and analytical skills.

Duties Description "The Program Research Specialist 4 (PRS 4) G-27 will play a vital role in the the Bureau of Managed Care Fiscal Oversight (BMCFO) which is responsible for overseeing Managed Care Organization's (MCOs) for regulatory compliance.

In the BMCFO's Medicaid Encounter Data Unit, the duties include overseeing encounter data reporting that provide outreach activities to MCOs to ensure mandated program compliance standards are met, managing and directing all aspects of research analysis, and evaluation encounter data for both mainstream Medicaid and Long Term Care MCOs which operate over 150 lines of business. Encounter oversight includes monitorinig compliance of encounter reporting specific to the submission of timely, accurate and complete encounter submissions by MCOs by developing and maintaining SAS and SQL coding using the Medicaid Data Warehouse (MDW) and OHIP Datamart. In addition, the Unit is responsible for the maintenance of the Medicaid Encounter Data Reporting for APD and MMCOR Category of Service - Service Utilization and Cost Reporting Guide that is used by MCOs to submit encounters. .

In the BMCFO's Fiscal Oversight Unit the duties include providing fiscal oversight of all MCOs for mainstream Medicaid, Long Term Care, commericlal HMO and Medicare Advantage Only MCOs. Those functions include monitoring MCOs for compliance with minimum reserve requirements, reviewing related party agreements, reviewing MCO mergers, acquisitions and expansions, along with reviewing MCO provider and management contract agreements for compliance with Federal and State requirements.
"

Additional Comments Permanent, full-time appointment.

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

Name Human Resources Management Group, CAC/PRS4/87744

Telephone 518-486-1812

Fax 518-473-3395

Email Address resume@health.ny.gov

Address

Street Room 2217, Corning Tower Building, Empire State Plaza

City Albany

State NY

Zip Code 12237

Notes on ApplyingSubmit cover letter and resume, preferably in PDF format, to Human Resources Management Group, CAC/PRS4/87744, Room 2217, Corning Tower Building, Empire State Plaza, Albany, New York 12237- 0012, or fax to (518)473-3395, or by email to Resume@health.ny.gov, with Reference Code CAC/PRS4/87744 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 will be accepted until December 17, 2021.