Medicaid Eligibility Examiner 2 (NY HELPS) - 15402, 15464, 60201, 15221

Medicaid Eligibility Examiner 2

The Medicaid Eligibility Examiner 2 (MEE 2) serves as a critical supervisor within the State Disability Review Unit (SDRU), leading a team of examiners to ensure that disability determinations are processed in strict accordance with State and Federal mandates. Tasked with managing a 90-day regulatory timeline, the incumbent provides technical guidance on complex cases, monitors workload distribution to prevent backlogs, and ensures rigorous HIPAA compliance in the handling of medical evidence. By maintaining high standards for accuracy and timeliness, the MEE 2 mitigates legal risks for the Department and prevents service delays that could jeopardize a client's access to essential healthcare.

Minimum Qualifications

Reassignment: Current New York State employee with one year or more of permanent or contingent-permanent, competitive service as a Medicaid Eligibility Examiner 2, SG-14.

Permanent Transfer: A New York State employee with one year or more of permanent or contingent-permanent, competitive service in a position allocated to SG-12 above and eligible for transfer under Section 70.1 of the Civil Service Law.

Non-Competitive Candidates via NY HELPS Program: Four years* of full-time experience performing one or more of the following six activities, in a program with one or more of the following functions: reimburses for health care services; works with social services program areas; determines eligibility for a consumer assisted program in a hospital or other health care facility; provides health care regulatory oversight; or performs quality assurance and interpretation/application of standards of health care. Activities include: determining eligibility for a health care program in which financial eligibility criteria must be met; performing utilization review, including pre-payment or post-payment review of requested health care services, prior approval or authorization activities, adjudication or pricing of claims for payment; or analysis of patterns of health care; determining reimbursement and financing of health care services, including rate-setting or approval, establishing capitation reimbursement methodologies, assessing fee schedules, coding constructs for medical goods and services, or applying/processing of reimbursement methodologies; performing quality assurance activities such as ensuring compliance with laws, rules, regulations, and policies; inspecting, assessing, or monitoring health care programs or facilities for certification, licensure, or adherence to laws, rules, regulations, and policies; planning, designing, developing, researching, or evaluating proposals to establish or refine programs, with ongoing responsibility for interpreting legislation or regulations, defining and describing target populations and local demographics, grant and proposal writing, or developing, reviewing, and evaluating contracts.

*Substitution: College credit hours may substitute for up to two years of experience at the rate of 30 college credits equaling one year of experience.

Provisional Appointment: In the absence of an eligible list with three or more candidates willing to accept a position, a temporary provisional appointment may be considered. For provisional appointment, candidates must meet one of the following minimum qualifications: Current New York State Department of Health employee with one year of permanent or contingent-permanent, competitive service as a Medicaid Eligibility Examiner 1 or Medicaid Eligibility Examiner 1 SL.

If three or fewer New York State Department of Health promotional candidates respond to this notice, the agency may, at its discretion, nominate a qualified employee for non-competitive promotion under the provisions of Section 52.7 of the Civil Service Law.

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.