Location: Albany,NY, USA
This title is part of the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS). HELPS Program titles may be filled via a noncompetitive appointment. This means that you do not need to take an exam to qualify, but you do need to meet the minimum qualifications of the title. If you are hired under the HELPS Program, you will be first be appointed as a temporary employee. In May 2024, if you are performing successfully in the position, your appointment will be changed from temporary to permanent non-competitive. Once you are in permanent status, your official probationary period will begin and you may take any promotion exam for which you are qualified. At a future date (within one year of permanent appointment), employees hired under NY HELPS are expected to have their permanent non-competitive employment status converted to permanent competitive status. You will not have to take an exam to gain permanent competitive status. NON-COMPETITIVE MINIMUM QUALIFICATIONS: 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. College credit hours may substitute for up to two years of experience at the rate of 30 college credits equaling one year of experience. COMPETITIVE MINIMUM QUALIFICATIONS: Current NYS employee with one year or more of permanent or contingent-permanent, competitive service as a Medicaid Eligibility Examiner 2 (G14) or Medicaid Eligibility Examiner 2 (Spanish Language) (G14), OR a NYS employee with one year or more of permanent or contingent-permanent, competitive service in a position allocated to a salary grade 12or above and eligible for transfer under Section 70.1 of the Civil Service Law. Preferred Qualifications: Fluent in Spanish Language with ability to translate both documents and phone recordings into English. Strong organizational skills; Excellent communication skills, both written and verbal; some supervisory exp. Experience with NYSOH specific programs including Medicaid, Child Health Plus, and/or the Essential Plan. Experience with prepping file folders for Administrative Hearings. Duties Description Provide translation from Spanish to English of both documents and phone recordings; Supervise staff that have been assigned to you; Track and coordinate the processing of appeals; Provide support to legal staff; Research status of appeals request; Proof reading and quality assurance; Data analysis and compilation; Planning and conducting staff training; Handling of federal and state audits; Assist in processing and monitoring appeals; Assisting in implementing policies and practices; Assist in managing and overseeing work on redaction of personally identifiable information from decisions and dismissals Additional Comments 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. 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: Some positions may require additional credentials or a background check to verify your identity. Name Human Resources Management Group, EM/MEE2(SL)(HELPS)/87301 Telephone 518-###-#### Fax (518) ###-#### Email Address ...@health.ny.gov Address Street Room 2217, Corning Tower Empire State Plaza City Albany State NY Zip Code 12237 Notes on Applying Please submit your resume and cover letter as one (1) document, preferably in PDF format, by email to ...@health.ny.gov, with Reference EM/MEE2(SL)(HELPS)/87301 included in the subject line or by mail to Human Resources Management Group, EM/MEE2(SL)(HELPS)/87301, Rm 2217, Corning Tower Building, Empire State Plaza, Albany, NY 12237-0012, or by fax to (518) ###-####. Failure to include the required information may result in your resume not being considered for this position.