FAIR HEARING ELIGIBILITY SPECIALIST

FAIR HEARING ELIGIBILITY SPECIALIST

The Office of the General Counsel / Fair Hearing Administration is recruiting for four (4) Eligibility Specialists, Level II to function as Fair Hearing Eligibility Specialists who will:

• Gather information regarding client eligibility for PHI from submitted forms, via face to-face contact, or via telephone to ensure compliance with State fair hearings decisions.
• Determine PHI eligibility based upon the pertinent laws, rules, regulations, and procedures in order to provide the appropriate action for each Fair Hearing appellant.
• Contact appellants to discuss eligibility and resolves as many cases as possible before the hearing is scheduled.
• Examine and verify client's eligibility information using the WMS and FHIS and examine the client's Aid to Continue (AC) eligibility and its ramifications for the case and instigates voluntary withdrawals from the fair hearing process.
• Process extension of Medical coverage for clients entitled to AC and whose Medicaid eligibility is scheduled to expire or has already expired. Process "clock down" lists by extending coverage for appellants whose hearings have not been scheduled or have been rescheduled.
• Provide information regarding PHI eligibility to current and potential clients via telephone and in person.
• Transmit the required Withdrawal of NYS OTDA Fair Hearing Request form (MAP- 316P) to the appellant in instances where the voluntary withdrawal is agreed to. Review the form to ensure that it is duly signed and complete upon its return.
• Maintain log of contact with clients, noting issues that have been resolved and cases that have been either resolved or withdrawn. Forward the MAP-316P form to the Record Management/Carfare Unit for addition to the appellant's file. Prepare daily, weekly, and monthly activity reports for submission to supervisory staff.
• Consult with the Unit Supervisor on overall problems and complicated cases as needed.

Hours/Shift: 9am - 5pm

ELIGIBILITY SPECIALIST - 10104

Minimum Qualifications

1. Completion of 30 semester credits at an accredited college or university; or 2. A four high school diploma or its educational equivalent and one year 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 recommendations concerning eligibility for public assistance or unemployment, health benefits, social security, insurance, or participation in social services or community programs, and 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 duties or a job in which the duties include helping customers with questions or concerns; or c. Dealing with social service agencies, legal representatives, or aiding individuals in navigating housing, social, financial or health problems or application systems; 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 or university 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.

Preferred Skills

- Must have extensive background in Medicaid eligibility and be able to complete all MA eligibility transactions in WMS. - Must be up to date in Medicaid Savings Program and how to accrete a case in the EmedNY system. - Must be able to communicate well with all consumers and act in a professional manner even when confronted with difficult consumers. - Must be able to move the interviews along to allow to meet the deadlines imposed by the State OTDA. - Work well under pressure, as well as, manage the interview process. - Must be organized, self-sufficient and be an independent starter. - The worker must be proficient in WMS eligibility actions, understand all budgeting types, understand Edits, Emendy and proficient in working with word and excel reports.

55a Program

This position is also open to qualified persons with a disability who are eligible for the 55-a Program. Please indicate at the top of your resume and cover letter that you would like to be considered for the position through the 55-a Program.

Public Service Loan Forgiveness

As a prospective employee of the City of New York, you may be eligible for federal loan forgiveness programs and state repayment assistance programs. For more information, please visit the U.S. Department of Education's website.

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.