Medicaid Eligibility Examiner 1/ Trainee (NY HELPS) - 15311

Duties Description These Medicaid Eligibility Examiner 1 (MEE 1) positions will work within the Bureau of Third-Party Health Insurance, Medicare Savings Program and Recoveries. Duties may include, but not be limited to: Review information submitted to Third-Party Liability Bureau (TPL) from a variety of sources including, but not limited to, Medicaid Managed Care Organizations (MMC), other internal units/Bureaus. Make the necessary determination regarding any necessary updates to eMedNY and possible MMC premium recovery. Analyze and verify Third Party Health Insurance (TPHI) relative to client information and perform verifications and 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. Review eMedNY, NYSoH, KTT, and JIRA to determine the status of checks and assist clients in resolving their questions. Review and resolve JIRA issues related to returned premium reimbursement checks, stop payment and reissue requests, 90-day letters, and payments received. Permanent Transfer Minimum Qualifications Current NYS Department of Health employee with permanent or contingent-permanent, competitive status as a Medicaid Eligibility Examiner (G9) OR a NYS employee with one year or more of permanent or contingent-permanent, competitive service in a position at or above a grade 6 and eligible for transfer under Section 70.1 of the Civil Service Law. Non-Competitive Via HELPS Medicaid Eligibility Examiner 1: Two years of experience determining or reviewing financial eligibility for healthcare or consumer-assisted programs to ensure individuals meet eligibility criteria specified in State and/or federal laws, rules, and regulations or performing quality assurance activities to ensure compliance with laws, rules, regulations, and policies in a health care delivery system including health care facilities; federal, State, or local health care agencies; hospitals; Medicaid programs; and/or other public or private health insurance programs. 30 semester credit hours can substitute for one year of experience. Medicaid Eligibility Examiner Trainee 1: There are no minimum education or experience requirements. If you are appointed to a Trainee title, upon successful completion of a 12-monthtraineeship, you will automatically advance to the full journey level of the title, Grade 9. Preferred Qualifications Preferred candidates will have strong analytical skills and the ability to pay attention to details and will also have good oral and written communication skills. Candidates should have proficiency in Microsoft Office (Word, Excel, Access); the ability to work well independently and as part of a team and to manage multiple priorities to meet deadlines. Professional experience in public health insurance programs, including New York's Medicaid, Medicare and/or Child Health Plus and supervisory experience is a plus. Additional Comments When reviewing qualifications, omissions and vagueness cannot be interpreted in the candidate’s favor. Candidates are responsible for providing accurate and clear descriptions of their experience demonstrating how they meet the minimum qualifications. This position is part of the NYS HELPS program. No examination is required. Benefits We offer a work-life balance and a generous benefits package, worth 65% of salary, including: Holiday & Paid Time Off Public Service Loan Forgiveness (PSLF) Pension from New York State Employees' Retirement System Shift & 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 And many more... The NYS Department of Health is committed to making New York a safer, healthier, and more equitable place to live. Understanding health equity, social determinants of health and health disparities is critical to accomplish our goal of eliminating health disparities. For more information on the NYS Department of Health's Mission, Vision, Values and Strategic Plan, please visit: If you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone View phone number on click.appcast.io or email View email address on click.appcast.io to make a request. The NYS Department of Health does not participate in E-Verify and does not sponsor visa applications. For new State employees appointed to graded positions, the annual salary is the hiring rate of the position (beginning of the salary range). Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations, and negotiated union contracts. #J-18808-Ljbffr New York State Department of Health