Medicaid Integrity Specialist 3

4 weeks ago


Albany, New York, United States New York State Civil Service Full time
Job Summary

The New York State Civil Service is seeking a highly skilled Medicaid Integrity Specialist 3 to manage the Administrative Remedies Unit and the Enrollment Unit within the Division of Medicaid Investigations (DMI). This role requires a strong understanding of the rules and regulations impacting enrollment and sanctions, including exclusion from Medicaid.

The successful candidate will be responsible for:

  • Managing two units, ARU and Enrollment, and currently three direct reports of Medicaid Integrity Specialist 2's.
  • Maintaining a working knowledge of the rules and regulations which impact enrollment and sanctions.
  • Coordinating regularly with the Department of Health, the Justice Center, and the State Education Department as it relates to interdependencies in addressing Medicaid enrollment and sanctions.

The ideal candidate will have excellent leadership and communication skills, with the ability to work effectively in a fast-paced environment. If you are a motivated and detail-oriented individual with a passion for healthcare program integrity, we encourage you to apply for this exciting opportunity.

Key Responsibilities:

  • Managing the workflow of the units to ensure required deadlines and appropriate timelines are met.
  • Reviewing 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.
  • Ensuring timely processing of the units' work to meet strict regulatory defined deadlines.

Requirements:

  • Eligibility for appointment requires being reachable on the OMIG promotional list for Management Specialist 3 (Albany) OR being a current New York State employee with one year of permanent or contingent-permanent service in a title eligible for transfer under Section 70.1 or 52.6 of the Civil Service Law.


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