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Case Reviewer

4 months ago

Brooklyn, United States New York City, NY Full time

Under supervision of the Ombudsman Unit Supervisor within the Medicaid Eligibility Information Services, with some latitude for independent initiative and judgment, the Medicaid Eligibility Specialist is responsible for interviewing Medicaid applicants and reviewing their documentation to determine eligibility for Medicaid.

The Office of Constituent Services (OCS) is seeking three (3) Eligibility Specialist II's to function as Case Reviewers.

The Case Reviewer will:

* Respond to inbound and outbound telephone calls received from clients and/or authorized

representatives with inquiries related to Medicaid coverage including possible questions related

to the Excess Income Program or the A/Rs responsibility towards the cost of their care (NAMI-Net

Available Monthly Income) if institutionalized.

* Interview and/or review documentation submitted by applicants/recipients (A/R) or authorized

representatives, to determine eligibility for Medicaid.

* Conduct a comprehensive review of applications including financial and legal documentation, as

well as paid or unpaid medical bills submitted by A/R and/or authorized representative

* Determine eligibility for the appropriate level of Medicaid coverage for MAGI and Non-MAGI A/Rs.
* Assist consumers who need further assistance in understanding the eligibility criteria to qualify for

the Excess Income Program.

* Prepare eligibility forms and notices to inform A/Rs of case disposition.
* Prepare daily activity logs of cases completed for submission to the supervisor.

Minimum Qualifications

1. Completion of 60 semester credits at an accredited college; or

2. A four-year high school diploma or its educational equivalent and two years of full-time satisfactory experience in one or more of the following areas; performing the work described below:

a. Interviewing, gathering information and/or preparing necessary documentation for the purpose of making decisions concerning eligibility for public assistance or unemployment, health benefits, social security, casualty, property or liability insurance, or other similar benefits; or

b. Performing bookkeeping, bank teller duties, housing office teller duties, purchasing agent, assistant store manager, sales representative responsible for accounts, or customer service representative responsible for making determinations; or

c. Dealing with social service agencies or aiding individuals in solving housing, social, financial or health problems as a community organization representative; or

3. A satisfactory combination of education and/or experience equivalent to "1" or "2" above. College education may be substituted for the experience in "2" above on the basis that 30 semester credits from an accredited college may be substituted for each year of required experience. However, all candidates must have at least a four year high school diploma or its educational equivalent.

Special Note

Work experience which provides only incidental opportunities to perform the job duties as described in "2a", "2b" and "2c" above are not acceptable for meeting the minimum qualification requirements. Examples of unacceptable work experience include, but are not limited to, experience as a token clerk, check-out clerk, sales clerk, teacher's aide, cashier, receptionist or secretary.

55a Program

This position is open to qualified persons with a disability who are eligible for the 55-a Program. Please indicate in your cover letter that you would like to be considered for the position under the 55-a Program.

Residency Requirement

New York City residency is generally required within 90 days of appointment. However, City Employees in certain titles who have worked for the City for 2 continuous years may also be eligible to reside in Nassau, Suffolk, Putnam, Westchester, Rockland, or Orange County. To determine if the residency requirement applies to you, please discuss with the agency representative at the time of interview.

Additional Information

The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.