Healthcare Eligibility Review Specialist

2 weeks ago

Albany, New York, United States State of New York Full time

Important Notice:

State agencies typically do not request personal or financial information from job applicants via text message or phone calls in relation to job postings. If you receive such requests, please confirm the identity of the requester before sharing any information.

For inquiries regarding this job listing, please reach out to the agency that posted the position using the contact details provided in the "Contact" section.


Job Overview:

The Healthcare Eligibility Review Specialist will be part of the Bureau of Program Review within the Division of Eligibility and Marketplace Integration. This role involves conducting pre- and post-eligibility assessments for Medicaid and Child Health Plus (CHPlus) programs, utilizing eligibility guidelines, evaluation criteria, and relevant data systems.


Key Responsibilities:
  • Assist in the testing, updating, and revision of standardized review tools and training resources.
  • Conduct thorough case investigations and identify cases that may present irregularities.
  • Generate samples for testing and review purposes.
  • Perform data analysis and compile review findings.
  • Draft and refine summary reports.
  • Oversee subordinate staff as necessary.

Minimum Qualifications:

To qualify for this position, candidates must meet one of the following criteria:

  • Six years of relevant experience in a healthcare delivery system.
  • An Associate's degree combined with four years of relevant experience.
  • A Bachelor's degree or higher with two years of relevant experience.

Relevant experience includes activities such as:

  • Developing health-related policies.
  • Analyzing and interpreting health policies to assist consumers.
  • Determining financial eligibility for healthcare programs.
  • Establishing reimbursement mechanisms for healthcare services.
  • Conducting utilization reviews for medical treatment requests.
  • Performing compliance reviews of healthcare facilities.

Preferred Qualifications:

Ideal candidates will possess:

  • Experience in public health insurance programs, particularly Medicaid and Medicare.
  • Strong verbal and written communication skills.
  • Excellent analytical abilities and attention to detail.
  • Proficiency in Microsoft Office applications.
  • The capability to work independently and collaboratively within a team.
  • Experience with electronic data systems.

Benefits:

The State of New York offers a comprehensive benefits package, which includes:

  • Generous paid time off and holidays.
  • Public Service Loan Forgiveness options.
  • Pension plan through the New York State Employees' Retirement System.
  • Competitive health care options.
  • Family dental and vision benefits at no extra cost.
  • Access to various savings programs.

For further details on the State of New York's commitment to health equity and the elimination of health disparities, please refer to the agency's mission and values.

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