Medical Assistance Specialist 1

1 week ago

Albany, New York, United States StateJobsNY Full time

Permanent Transfer:

Current Department of Health (DOH) employees with permanent or contingent-permanent status as a Medical Assistance Specialist 1; 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, Section 70.1 of the Civil Service Law to a Medical Assistance Specialist 1.

For more information on the types of transfers, transfer eligibility criteria, and the current transfer determinations for your title, visit the following Minimum Qualifications : Either 1: Six years of qualifying experience;Or 2: an Associate's degree AND four years of qualifying experience;Or 3: a Bachelor's or higher degree AND two years of qualifying experience

Qualifying experience:
For the purposes of this examination, qualifying experience is performing one or more of the following activities in a health care delivery system including health care facilities; federal, State, or local health care agencies; hospitals; Medicaid programs; and/or other public or private health insurance programs:
  • 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.-Conducting independent examinations of health care facilities or program integrity reviews of health care programs to ensure compliance with laws, rules, and regulations.


Preferred Qualifications:

Preferred candidates will have professional experience in public health insurance programs, including New York's Medicaid, Medicare and/or Child Health Plus.

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. Duties Description These incumbents will work within the DEMI Bureau of System Quality Assurance.

The Bureau conducts quality assurance 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, Essential Plans, and Qualified Health Plans, including APTC, if related enrollment functionality is correct; and ensuring systems are operating in a manner consistent with federal and state statute and regulations.

Specific duties may include, but not be limited to:

  • Conduct quality assurance (QA) reviews of the NYSOH Marketplace performance relating to program eligibility determinations, enrollment functionality and notice generation/consumer messaging.
  • 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, and resolve issues, and provide technical guidance.
  • Function as a QA Testing Coordinator. Conduct testing of NYSOH current and scheduled functionality/validation.
  • Prepare or review training documents and deliver training to small or large groups.
  • Submit and track defects and enhancements related to all functional areas of the NYSOH Marketplace related to eligibility, enrollment, notices and customer assistance for Medicaid and other financial assistance programs.
  • Participate in special projects and Bureau Initiatives, as needed.
  • May supervise subordinate staff. Additional Comments The Medical Assistance Specialist 1 title is part of the NYS HELP program. For the duration of the HELP Program, this title may be filled via permanent non-competitive appointment, which means no examination is required but all candidates must meet the minimum qualifications of the titles for which they apply. At the close of the HELP program, employees hired under the HELP Program will have their non-competitive employment status converted to competitive status. Employees will then be afforded with all of the same rights and privileges of competitive class employees of New York State.
Depending on how the candidates qualifies, the positions could be filled as competitive or non-competitive.

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 WDW/MAS1/79640 Telephone Fax Email Address AddressStreet Rm 2217, Corning Tower Building, 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 WDW/MAS1/79640 included in the subject line or by mail to Human Resources Management Group, WDW/MAS1/79640, 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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