Medicaid Integrity Specialist 1/Trainee 1/Trainee 2 (2 positions) NY HELPS - #9828149

Minimum Qualifications

This title is part of the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS)**

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

• Bachelor’s degree* or higher
• Advanced placement to the Trainee 2 or Grade 18 level may be possible depending on education and experience.
• Your degree must have been awarded by a college or university accredited by a 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.

70.1 Transfer

• For a 70.1 transfer to this title, you must have one year of permanent or contingent-permanent competitive service in a 70.1 title allocated to a salary grade 16 or above (11 or above for a Trainee 1, 12 or above for a Trainee 2).
  
  

70.4 Transfer

• For a 70.4 transfer to this title, your current title must be within two salary grades, and either be on the PCO or be on the PATT and possess a bachelor’s degree. Your score on either the PCO or PATT does not need to be reachable.
  
  

52.6 Transfer

• For a 52.6 transfer to this title, you must have one year of permanent or contingent-permanent service in a 52.6 title allocated to a salary grade 16 or above (11 or above for a Trainee 1, 12 or above for a Trainee 2).
  
  

To determine if your current Civil Service title is eligible for transfer to this title, visit the NYS Civil Service Career Mobility GOT-IT website: Career Mobility Office » GOT-IT (ny.gov)

Appointments via transfer must not result in a second, consecutive transfer with an advancement of more than two S-grades or one M-grade.

55-b/c Program Appointments

For a 55 b/c appointment, you must:

• Possess the minimum qualifications for the selected title as established by the Department of Civil Service and listed on the most recent exam announcement.
• Meet the applicable minimal mental and/or physical requirements for the job (with a reasonable accommodation, if necessary)
• Have a current Eligibility Letter from the NYS Department of Civil service, www.cs.ny.gov/rp55/, and be able to provide it to the Human Resources Office upon request.
• If you are currently 55b/c eligible and possess a bachelor’s degree, we encourage you to apply for this position.
  
  

Depending on qualifications, you may be required to serve a 1 or 2-year traineeship that leads to the full level grade 18 position.

Preferred Qualifications

Previous experience as a Medicaid Integrity Specialist 1, or experience in the Transportation industry or in a healthcare related position. Proficient skills in Microsoft Excel and Word.

Duties Description

The Division of Medicaid Investigations (DMI) ensures the integrity of the Medicaid program by conducting investigations, recovering overpayments, implementing administrative sanctions against providers and/or recipients, and can refer for criminal prosecution.

Benefits

The Medicaid Integrity Specialist 1 will function as a member of the Transportation Prepayment Claims Review Team within the Bureau of Payment Controls & Monitoring in DMI. The incumbent will work as a team member with other Medicaid Integrity Specialists and Investigators to work within the Prepayment Claims Review system in eMedNY which is a criteria-based claims resolution system that selectively suspends payment of a provider’s claims (pend) and allows staff the opportunity to review all, or a portion of a providers claims prior to payment. Regulatory authority for prepayment claims review is contained in the New York State Codes, Rules and Regulations, Title 18 NYCRR, Part 504.8 (4)(b)(c)(d). The Prepayment Claims Review process is conclusive. The benefits derived from the prepayment claims review process are unique in the OMIG and the prepayment claims review function can be used as:

• A provider compliance tool monitoring all or a portion of their activity
• A tool to deter a specific activity
• A fraud detection tool
• A provider education tool
• A quality-of-care review tool
  
  

The duties of the position include, but are not limited to:

• Collaborating with investigative staff on Transportation related Prepayment Claim Reviews as needed.
• Performing review and processing of pended Transportation claims, assuring appropriate determinations.
• Performing research and data collection to support Transportation prepayment review actions.
• Assisting in building criteria to capture and process Transportation claims.
• Manually reviewing claims history for identified Transportation Providers.
• Opening cases in PACS, tracking case progress, and closing cases when complete.
• Monitoring the billing patterns and practices of identified dental providers.
• Assisting with special projects as needed.
• Aiding in data review.
• Communicating orally and in writing with team members, Investigators, other agencies, the provider community, and their legal counsel as necessary.
• Working with OMIG program and system staff as necessary.
  
  

Additional Comments

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

• 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.

Trainee 1 salary starts at $49,363. Salary is non-negotiable.