What are the responsibilities and job description for the Eligibility Program Manager 1 (NY HELPS) - 79585 position at State of New York - Health, Department of?
Duties Description This position is in the Division of Eligibility and Marketplace Integration, Bureau of Business Requirements and Notices. Staff in this position will support activities related to: implementing new Medicaid eligibility and enrollment initiatives; gathering and analyzing Medicaid and other financial assistance program requirements for the new and existing eligibility systems; and providing technical assistance on Medicaid eligibility and enrollment system requirements to systems integrators.
Specific duties and responsibilities may include, not be limited to:
Provide supervision, guidance, and oversight to subordinate staff; intervene and resolve problems as necessary.
Determine and oversee staff assignments and reassignments; evaluate performance; monitor time and attendance; and approve leaves and the use of overtime.
Lead or participate in tasks involving requirements gathering, validation of requirements with policy staff, and analysis and provision of business requirements for the existing and new eligibility system to vendors and/or other DOH staff.
Direct staff on developing eligibility and notice requirements.
Manage oversight of staff assignments related to change requests and track staff assignments related to Eligibility, Enrollment and Notices requirements gathering.
Provide clarification of federal eligibility regulations and State requirements to other Department of Health units, other State agencies, local departments of social services, and other internal and external stakeholders.
Analyze and review staff work to determine if the eligibility system (NYSOH, MECM or Downstate WMS) is correctly determining eligibility, sending appropriate enrollment transactions, and generating appropriate notices.
Interpret guidelines and instructions related to eligibility, enrollment and notice issues from a quality assurance perspective; performs analysis for bureau and division-level staff; and makes recommendations for improvement.
Permanent Transfer Candidates:
New York State employee with one or more years of permanent or contingent-permanent service in title at Grade 25 or above, and eligible for transfer to Eligibility Program Manager 1, G-27, under section 70.1 or 52.6 of the Civil Service Law.
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.
NY HELPS Non-Competitive Minimum Qualifications
Eight years of professional experience*, two years of which must have included second-level supervision of staff, performing one or more of the following seven activities in a program with one or more of the following functions: provides reimbursements 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
1. Overseeing and directing staff in determining eligibility for a health insurance program or consumer assisted program in which financial eligibility criteria must be met.
2. Overseeing and directing staff in performing utilization review, including prepayment 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.
3. Overseeing and directing staff in developing mechanisms for the reimbursement and financing of health care services, including rate-setting or approval, capitation reimbursement methodologies, fee schedule development, coding constructs for medical goods and services, or application and processing of reimbursement methodologies.
4. Administering and overseeing staff responsible for day-to-day program operations for budgeting, staffing, or program planning.
5. Overseeing and directing staff in inspecting, assessing, or monitoring health insurance programs or health care facilities for certification, licensure, or adherence to laws, rules, regulations, and policies.
6. Overseeing and directing staff in planning, designing, developing, researching, or evaluating proposals to establish or refine health related programs, with responsibility for interpreting legislation or regulations, defining and describing target populations and local demographics, grant and proposal writing, or developing, reviewing, and evaluating contracts.
7. Administering and overseeing staff responsible for performing quality assurance activities such as ensuring compliance with laws, rules, regulations, and policies, as it pertains to activities 1 through 6.
- A bachelor's degree can substitute for four years of experience; a master's degree can substitute for five years of experience.
Preferred Qualifications: Experience in public health insurance programs, including New York’s Medicaid and/or Child Health Plus
Experience with data systems including, but not limited to, the Welfare Management System (WMS), NY State of Health Back Office and eMedNY;
Ability to research and analyze information
Demonstrated experience in requirements gathering and analysis of policy guidance
Strong, writing, verbal communication, interpersonal, and organization skills and ability to work well under pressure.
Supervisory experience
The candidate must have strong organizational skills and the ability to adapt to changing priorities and tight timeframes.
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: https://health.ny.gov/commissioner/index.htm
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 518-486-1812 or email doh.sm.reasonable.accommodation@health.ny.gov 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.
Benefits:
Health Insurance, Vacation & Paid Time Off, Pension PlanSalary : $106,898 - $131,665