Medical Assistance Specialist 1 (NY HELPS) - 88858

Medical Assistance Specialist 1 (MAS 1)

These Medical Assistance Specialist 1 (MAS 1) incumbents will work within the DEMI Bureau of System Quality Assurance. The Bureau conducts quality assurance and audit reviews of the NYSOH Marketplace performance relating to program eligibility determinations, enrollment functionality and notice generation.

The incumbents will be reviewing accounts to ensure that eligibility was determined correctly for Medicaid, Child Health Plus and Qualified Health Plans, including APTC, and if related enrollment functionality is correct; and ensuring systems are operated in a manner consistent with federal and state statute and regulations.

Specific duties may include, but not be limited to:

• Conduct quality assurance (QA) reviews of the NYSOH Marketplace performance relating to program eligibility determinations, enrollment functionality and notice generation/consumer messaging.
• Initiate and complete tasks necessary to produce and implement needed system change requests (CRs).
• Work with teams of vendors, DOH staff and other stakeholders as needed (e.g. issuers, application assistors) to elicit, document, analyze, and resolve issues, and provide technical guidance.
• Prepare or review training documents and deliver training to small or large groups.
• Submit and track defects and enhancements related to all functional areas of the NYSOH Marketplace related to eligibility, enrollment, notices and customer assistance for Medicaid and other financial assistance programs.
• Participate in special projects and Bureau Initiatives, as needed.
• Supervise subordinate staff.

Reassignment: Current NYS Department of Health (DOH) employee with permanent or contingent-permanent status as a Medical Assistance Specialist 1, G-18.

Transfer: Current NYS employee with one year or more of permanent or contingent-permanent, competitive service in a title eligible to transfer under Section 52.6 or Section 70.1 of the Civil Service Law to a Medical Assistance Specialist 1, G-18.

NY HELPS: Six years of experience developing public or private health related policy; analyzing AND interpreting public or private health related policy to assist consumers; 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; establishing mechanisms for the reimbursement and financing of health care services, including rate-setting, development of capitation reimbursement methodologies, and development of fee schedules; performing utilization review of requests for medical treatment including prior approval or authorization activities, adjudication of claims for payment and/or provider credentialing; AND/OR conducting independent examinations of health care facilities or program integrity reviews of health care programs to ensure compliance with laws, rules, and regulations.

Substitution: An associate degree can substitute for two years of specialized experience; a bachelor's degree can substitute for four years of experience; a master's degree in a related field can substitute for five years of experience; and a doctorate in a related field can substitute for six years of experience.

Preferred Qualifications: Preferred candidates will have professional experience in public health insurance programs, including New York's Medicaid and/or Medicare. Preferred candidates will also have excellent verbal and written communication skills; strong analytical skills and attention to detail; strong organizational skills; proficiency in Microsoft Office (Word, Excel, Access); the ability to work well independently and as part of a team, and to manage multiple priorities in order to meet deadlines; and experience using electronic data systems, such as eMedNY and NYSOH Back Office. Supervisory experience is a plus.

This position is part of the NYS HELPS program. No examination is required.

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.

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 (beginning of the Salary Range) of the position. 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.

Some positions may require additional credentials or a background check to verify your identity.