These Medical Assistance Specialist 1 (MAS 1) incumbents will work within the DEMI Bureau of System Quality Assurance. The Bureau conducts quality assurance and audit reviews of the NYSOH Marketplace performance relating to program eligibility determinations, enrollment functionality and notice generation.
The incumbents will be reviewing accounts to ensure that eligibility was determined correctly for Medicaid, Child Health Plus and Qualified Health Plans, including APTC, and if related enrollment functionality is correct; and ensuring systems are operated in a manner consistent with federal and state statute and regulations. Specific Duties May Include, But Not Be Limited Toto program eligibility determinations, enrollment functionality and notice generation/consumer messaging.
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 Preferred Qualifications: 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. 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: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:
If you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone 518-486-1812 or email doh.sm.reasonable.accommodation@health.ny.gov to make a request. NYS Department of Health does not participate in E-Verify and does not sponsor visa applications. 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....comprised of over 150 Board Certified physicians serving patients and communities throughout Maine and northern New England. Coastal Anesthesiology is a Spectrum Division dedicated to providing excellence in anesthesiology, pain management and perioperative care in a...
...manage the podcast content calendarPrepare hosts and guests for recordingsIdentify, source, and coordinate additional talent and production crew as neededSupport filming sessions and assist with post-production editingPublish episodes and help drive audience engagement...
...available Are you passionate about customer success, cyber security, and delivering outstanding service outcomes? We're seeking an experienced Service Delivery Manager (SDM) to become the trusted advisor and primary relationship owner for a portfolio of cyber...
...Job title: Executive Housekeeper Reports to: General Manager Job purpose The Executive Housekeeper is at the core of hotel operations. The primary duty of the Executive Housekeeper is to ensure the cleanliness and orderliness of all hotel rooms and public areas....
History & Humanities Experts is a remote review track for evaluating AI outputs across history humanities experts research review reasoning, calculations, and research workflows. Reviewers grade derivations and assumptions, reproduce key results, and document the correct...