Medicaid Integrity Specialist 3

3 days ago

Albany, New York, United States StateJobsNY Full time
Job Summary

The Medicaid Integrity Specialist 3 will serve as the manager over the Administrative Remedies Unit and the Enrollment Unit within the Division of Medicaid Investigations (DMI). This role requires a strong understanding of Medicaid program rules and regulations, as well as excellent leadership and communication skills.

Key Responsibilities
  • Manage two units, ARU and Enrollment, and currently three direct reports of Medicaid Integrity Specialist 2's.
  • Maintain working knowledge of the rules and regulations which impact enrollment and sanctions, including exclusion from Medicaid.
  • Coordinate regularly as the primary liaison with the Department of Health, the Justice Center, and the State Education Department as it relates to interdependencies in addressing Medicaid enrollment and sanctions.
Requirements
  • Updating, drafting, and implementing templates, policies, and procedures to support consistent and efficient operations of the units.
  • Monitoring the workflow of the units to ensure required deadlines and appropriate timelines are met. Addressing and correcting work production issues identified.
  • Reviewing the program integrity reviews conducted by staff and ensuring appropriate OMIG actions.
  • Signing final OMIG determination notices for public issuance.
  • Addressing appeals resulting from OMIG actions which may include participating at Appeals Committee meetings and/or drafting affidavits related to appeals and testifying in court as necessary.
  • Ensuring timely processing of the units' work to meet strict regulatory defined deadlines.
  • Drafting and providing routine reports on the units' work including weekly report submissions for review by DMI Management, OMIG Executives, and the Governor's Office, and contributing to OMIG's Annual Report.
  • Participating in regular internal and external audits of the units' work including audits by OMIG's Office of Internal Audit and Controls, the Office of the State Comptroller, and the Centers for Medicaid and Medicaid Services (CMS). Participation requires providing responses to audit questions including evidence of compliance with audit related requirements. In addition, the MIS 3 will be responsible for representing the Units at opening and exiting conferences.
  • Representing the units on various special projects including but not limited to inter- and intra-agency projects. Current projects relate to development and revision to software systems used by the units which support unit functions. Representation requires communicating the business requirements of the units to be incorporated into system development and upgrades.
  • Making recommendations to leadership related to cost savings initiatives, legislative, regulatory, and/or contract changes needed to support changes in the Medicaid program and/or strategic priorities, including Medicaid Redesign Team initiatives. Participating on implementation teams convened following approved recommendations.

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