Medicaid Integrity Specialist 1/Trainee 1/Trainee 2 (NY HELPS)

Description

Duties Description

This position is located within the Bureau of Self-Disclosure. The applicant will be responsible for the review and processing of incoming and existing self-disclosure submissions. The candidate will be expected to become knowledgeable in Self-Disclosure Program requirements, including the laws and regulations that impact recovery in this area. As OMIG has seen an increase in Self-Disclosure activity in recent years and expects this trend to continue, this position is at times fast-paced with fluid responsibilities. The successful candidate must be able to learn new subject matter, is detail-oriented, and able to pivot quickly to meet reprioritized tasks. They will be able to work both independently and as part of a team, and will need to possess strong communication skills, both written and verbal.

Previous experience or an aptitude for data analysis is preferred. Experience in reviewing and editing documentation is preferred. Prior knowledge of the Medicaid program and Medicaid data would be desirable.

Responsibilities

Including but are not limited to:

• The review and processing of incoming and existing self-disclosure submissions. This will require attention to detail. Experience in reviewing, editing, or writing is preferred. Prior knowledge of the Medicaid program would be desirable.
• Conducting research utilizing various sources to understand the disclosed error or issue that occurred.
• Ensuring regulation and policy is adhered to throughout the self-disclosure process, including implementation of guidelines which require the provider to submit a fully documented, detailed explanation and valid claims accounting of the self-disclosure.
• Working closely with providers and/or their representatives to obtain information/documentation to process disclosures. Drafting and sending correspondence to providers and other stakeholders including letters and emails.
• Review and analysis of Medicaid claim data to include the use of eMedNY, SQL developer, and the Medicaid Data Warehouse. Previous experience or an aptitude for data analysis is preferred.
• Management of a caseload of approximately 50 cases. Working within OMIG’s FACTS/PACS database system to document work and update cases as needed. Experience in Microsoft Office Suite products including Outlook, Word, and Excel is preferred.
• Participation in the creation and/or the presentation of educational material to OMIG staff and to external stakeholders regarding the Self-Disclosure program may be required
  
  

Qualifications

Minimum Qualifications

GENERAL PUBLIC: To be considered for appointment through NY HELPS, candidates must meet the open-competitive minimum qualifications for this position.

Appointment To The Trainee 1 Level Requires

• Four years of experience* in the promotion of Medicaid program integrity and appropriate delivery and utilization of Medicaid programs and services; OR
• Associate’s degree* AND two years of experience; OR
• Bachelor’s degree*
• Medicaid programs and services include: educating, assisting, and monitoring compliance with program regulations and obligations; developing, clarifying, and ensuring implementation of program requirements; collecting and analyzing data; evaluating and assessing appropriateness of provider or recipient participation in the Medicaid program or the appropriateness of billing or utilization of service; or developing referrals for further action or recommendations for corrective action.
• Advanced placement to the Trainee 2 or Grade 18 level may be possible depending on education and experience. It is essential that candidates clearly and concisely indicate exactly how they meet the above minimum qualifications in their resume. Failure to show how you meet the minimum qualifications above may result in disqualifications and removal from consideration.
• Your degree must have been awarded by a college or university accredited by regional, national, or specialized agency recognized as an accredited agency by the U.S. Department of Education/U.S. Secretary of Education. If your degree was awarded by an educational institution outside of the United States or its territories, you must provide independent verification of equivalency. This information can be found at http://www.cs.ny.gov/jobseeker/degrees.cfm. Candidates are responsible for the evaluation fee.
  
  

CURRENT NYS EMPLOYEES- Competitive Minimum Qualifications

Current New York State Employee with one year or more of permanent or contingent-permanent competitive service, or 55 b/c service as a Medicaid Integrity Specialist 1; OR current New York State Employee with one year or more of permanent or contingent-permanent service or 55 b/c service in a qualifying title and eligible for transfer under Section 70.1, 70.4, or 52.6 of the Civil Service Law.

PREFERRED QUALIFICATIONS: The preferred candidate will be proficient with Microsoft Office suite and have excellent written communication, verbal communication, and time management skills. The candidate should be able to work both as part of a team and independently, with a willingness and aptitude to learn new content. Familiarity with the Medicaid program and Medicaid data is preferred. Familiarity with eMedNY, the Medicaid Data Warehouse, and SQL Developer is desirable.

Excellent written and oral communication, including grammar and editing skills; critical, independent thinking, and analytical skills; excellent reading comprehension.

Proficiency with Microsoft Office Suite and ability to learn new data systems.

Additional Comments

Permanent, Full-Time, Competitive (for transfer and appointments off a list), Non-Competitive (for appointments through the NY HELPS Program).

Salaries Are Non-negotiable

• The Department of Civil Service has developed the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS), which is a streamlined program that allows appointment to this title and others without examination.
  
  

For the duration of the NY HELPS program, this title, may be filled via permanent, non-competitive appointment, which means no examination is required but all candidates must meet the minimum qualifications of the titles for which they apply.

NOTE ON TELECOMMUTING: OMIG employees may be approved for a maximum of 50% telecommuting, however, they are required to apply and obtain approval through management in accordance with OMIG's Telecommuting Program Guidelines.