Medicaid Integrity Specialist 1/Trainee 1/Trainee 2 *2 Positions

Duties Description These positions are in the Recovery Audit Contractor (RAC) unit within the Bureau of Third-Party & Payment Oversight. Over the course of the traineeship, the candidates will learn to use databases and software programs available for Medicaid research, including eMedNY and the Medicaid Data Warehouse (MDW). These programs will aid staff in the development of Medicaid audits, analyzing data, and make well-reasoned determinations for Medicaid audits.

Responsibilities include, but are not limited to:

• Collaborating closely with the Recovery Audit Contractor to facilitate the newly approved Inpatient Hospital Audits
• Collaborating closely with the Recovery Audit Contractor to facilitate reviews through the Draft Audit Report and Final Audit Report procedures
• Contacting appropriate internal OMIG stakeholders and external stakeholders for addressing RAC’s needs, questions, vetting of RAC audits, and/or following up on outstanding audits
• Aiding in the research and preparation of various documents related to the policies and processes of the RAC Unit
• Open FACTS cases and maintain/update throughout the DAR/FAR process
• Vet provider and Manage Care plans
• Supporting the contractor in the preparation and distribution of each DAR and FAR, as well as monitoring the status of each issue reported
• Tracking various repayment collection methods from providers for each DAR/FAR, entering relevant repayment information into the OMIG’s data management tracking systems, and updating audit reports of repayments, as deemed appropriate
• Create ad-hoc reports in OMIG’s data management tracking system
• Analyzing and vetting submitted claim data by the contractor for accuracy and to prevent intra-agency duplication prior to the issuance of each DAR/FAR
• Responding to inquiries from providers and attorneys concerning both contractor and OMIG audits
• Coordinating with contractors, various division, and the provider community
• Collaborating with Office of Counsel on the preparation of documents and hearings
• Verifying and analyzing OSC methodologies
  

Minimum Qualifications 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.
  

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:

Preferred candidates will have excellent verbal and written communication skills; strong analytical skills and attention to detail, strong organizational skills; the ability to work as part of a team; proficiency in Microsoft Office Programs, specifically Word, Excel, and Outlook; ability to analyze claims data.