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

Description

Duties Description

This position will be responsible for informing and advising the Bureau of Casualty & Estate Recovery and Division Management regarding statute, regulation, and sub regulatory guidance as it applies to casualty (personal injury), estate, and real property recovery cases.

The successful applicant will be expected to become a subject matter expert in Casualty & Estate (C&E) recovery in New York including the laws, regulations, and sub regulatory guidance that impact recovery in these areas. This includes staying abreast of federal and state law, regulation, and policy changes that may impact the program. The applicant will need to leverage this knowledge daily to advise the BCE team, OMIG Management, OMIG’s Office of Counsel (OC), and the C&E contract vendor, both in general policy and as it applies to specific cases.

Duties of this position include, but are not limited to:

• Identification and management of statutory, regulatory, and policy impacts to New York’s Casualty and Estate recovery efforts on a federal, state, and local level.
• Working collaboratively with division and agency management to identify program and policy recommendations that further the agency mission and adhere to federal requirements. Assist in the creation, updating, and maintenance of the Bureau Manual, and of all protocols and procedures related to Casualty & Estate Recovery Unit.
• Participation in the creation of additional Request For Proposal as connected with the C&E Recovery program.
• Works with OMIG’s Office of Counsel to track, research, obtain, and verify the accuracy of legal documents. Maintain ongoing communication with the Vendor to ensure proper and timely handling of correspondence relating to recovery cases.
• Prospectively sample and review cases across all areas and types within the case management database system and provided within reports received to ensure accuracy, timeliness and workflow within C&E recovery efforts.
• Receive and process incoming C&E related inquiries from other OMIG Units, the public, other NYS agencies, and local county Department of Social Services offices.
• Identify and track concerns/questions raised by various stakeholders, their resolution, and impacts to the larger program or existing processes.
• Liaison as needed with the various internal and external stakeholders including OMIG’s contract vendor, OMIG OC, DOH, OPWDD, various Local Departments of Social Services (LDSS), various court system representatives, various law firms, and Medicaid recipients and their families. Assist in meeting preparation and conducting meetings as requested.
• Learn and/or seeks training in the software and computer systems used by the Bureau to become proficient in these computer tools.
  
  

Qualifications

Minimum Qualifications

The preferred candidate will have excellent written and verbal communication, as well as organizational and time management skills. Prior knowledge of New York State estate and/or personal injury law, liens, and/or legal processes and/or proceedings in general, is greatly preferred. Familiarity and skill with research and applying learned information is required.

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.