Medicaid Eligibility Examiner

4 weeks ago

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

We are seeking a highly skilled Medicaid Eligibility Examiner to join our team at the New York State Department of Health. As a Medicaid Eligibility Examiner, you will play a critical role in ensuring that individuals and families receive the healthcare benefits they need.

Key Responsibilities
  • Review and analyze information submitted to the Third-Party Liability Bureau to determine eligibility for Medicaid benefits.
  • Verify Third Party Health Insurance (TPHI) information and perform determinations as they apply to Medicaid Managed Care enrollment.
  • Determine when action is necessary regarding recovery of capitation payments and direct the necessary information to the appropriate individual or unit to initiate the recovery process.
  • Take appropriate actions regarding Medicaid enrollment and premium reimbursement.
  • Create and modify HIPP/MIPP payees as necessary.
  • Gather information from employers and/or insurance carriers for determining cost-effectiveness of TPHI.
  • Calculate the cost-effectiveness of TPHI using the HIPP calculator in eMedNY.
  • Communicate via phone with MMC Plans, carriers, clients, and coworkers.
  • Handle incoming phone calls from Medicaid clients with questions about their premium reimbursement checks.
Requirements

To be successful in this role, you will need:

  • Strong analytical skills and attention to detail.
  • Excellent oral and written communication skills.
  • Proficiency in Microsoft Office (Word, Excel, Access).
  • Ability to work well independently and as part of a team.
  • Ability to manage multiple priorities to meet deadlines.
What We Offer

We offer a competitive salary, a comprehensive benefits package, and a work-life balance that will allow you to thrive in your career and personal life. As a member of our team, you will have access to:

  • Generous paid time off and holidays.
  • Public Service Loan Forgiveness (PSLF) program.
  • Pension from the New York State Employees' Retirement System.
  • Shift and 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.

We are an equal opportunity employer and welcome applications from diverse candidates. If you are passionate about making a difference in the lives of others and have the skills and experience we are looking for, please submit your application today.

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