Job Description

The Medical Assistance Program (MAP) administers public health insurance programs, including Medicaid, for the City of New York. Applying individuals and families are approved for eligibility against applicable Federal and State guidelines. Those found to be eligible can use coverage provided to access doctors, medication and other health care services at little or no cost.

The Medical Assistance Program (MAP) is recruiting for three (2) Eligibility Specialist II to function as a Medicaid Eligibility Specialist, in MAP's Managed Care Client Services' Unit who will:

- Conduct a comprehensive review of applications including financial and legal documentation, as well as paid or unpaid medical bills submitted by applicants/recipients and authorized representatives.

- Perform budget calculations, obtain clearance reports, resolve resource matches and initiate other case actions utilizing the Eligibility Data and Image Transfer System (EDITS), Welfare Management System (WMS), MAP Pay-In System, eMedNY and the HRA One viewer.

- Determine eligibility for the appropriate level of Medicaid coverage for MAGI and Non-MAGI applicants and recipients.

- Prepare eligibility forms and notices to inform applicants and recipients of case disposition.

- Interview and/or review documentation submitted by applicants and recipients or authorized representatives, to determine eligibility for Medicaid.

- Respond to inbound and outbound telephone calls received from clients and/or authorized representatives with inquiries related to Medicaid coverage including possible questions related to the Excess Income Program or the applicant or recipients' responsibility towards the cost of their care (NAMI-Net Available Monthly Income) if institutionalized.

- Assists consumers who need further assistance in understanding the eligibility criteria to qualify for the Excess Income Program.

- Perform other related assigned duties.

Qualifications

1. Completion of 60 semester credits at an accredited college; or

2. A four-year high school diploma or its educational equivalent and two years of full-time satisfactory experience in one or more of the following areas; performing the work described below:

a. Interviewing, gathering information and/or preparing necessary documentation for the purpose of making decisions concerning eligibility for public assistance or unemployment, health benefits, social security, casualty, property or liability insurance, or other similar benefits; or

b. Performing bookkeeping, bank teller duties, housing office teller duties, purchasing agent, assistant store manager, sales representative responsible for accounts, or customer service representative responsible for making determinations; or

c. Dealing with social service agencies or aiding individuals in solving housing, social, financial or health problems as a community organization representative; or

3. A satisfactory combination of education and/or experience equivalent to "1" or "2" above. College education may be substituted for the experience in "2" above on the basis that 30 semester credits from an accredited college may be substituted for each year of required experience. However, all candidates must have at least a four year high school diploma or its educational equivalent.

Special Note

Work experience which provides only incidental opportunities to perform the job duties as described in "2a", "2b" and "2c" above are not acceptable for meeting the minimum qualification requirements. Examples of unacceptable work experience include, but are not limited to, experience as a token clerk, check-out clerk, sales clerk, teacher's aide, cashier, receptionist or secretary.

Additional Information

The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.