Health Systems Specialist 1/Trainee 2/Trainee 1 - 80151

Duties Description In the Office of Health Insurance Programs's Division of Health Plan Contracting and Oversight, within the Bureau of Managed Long Term Care, the Health Systems Specialist 1 position will work in the Bureau's Systems Unit. Responsibilities will include but not be limited to: 1. Learning the Department's multiple eligibility systems and assisting in reviewing eligibility requirements. Acting as primary contact in processing of MLTC and MAP enrollments and disenrollments in the eligibility systems. 2. Focusing on aligning with federal requirements for PACE Plans. Acting as a primary contact in processing of PACE enrollments and disenrollments in the eligibility systems. 3. Solutioning coverage code errors and eligibility stacking errors with Local Districts of Social Services (LDSS) and Department stakeholders. 4. Cross training in all major System Unit functions including processing hospice requests; assisting with systems needs for acquisitions/mergers, new plans, and plan closures as needed, etc. 5. Assisting as a back-up for Coordination of Benefits Agreements (COBA) and Fair Hearing processes.

Minimum Qualifications Permanent Transfer:
Current New York State employee with one year or more of permanent or contingent permanent, competitive service in a Health Systems Specialist 1 (G18) position OR a NYS employee in a position G16 or higher and eligible for transfer under Section 70.1 or Section 70.4 of the Civil Service Law.

Non-Competitive via NY HELPS:
Health Systems Specialist 1: Six years of experience performing or implementing medical or programmatic surveillance, audit, compliance, quality assurance, or regulatory activities for patients or a health care delivery system for a health care facility or health related organization.

Health Systems Specialist Trainee 2: Five years of experience performing or implementing medical or programmatic surveillance, audit, compliance, quality assurance, or regulatory activities for patients or a health care delivery system for a health care facility or health related organization.

Health Systems Specialist Trainee 1: Four years of experience performing or implementing medical or programmatic surveillance, audit, compliance, quality assurance, or regulatory activities for patients or a health care delivery system for a health care facility or health related organization.

Substitution:
Associate degree may substitute for two years of specialized experience; bachelor's degree may substitute for four years of specialized experience; master's degree may substitute five years of specialized experience; . may substitute for six years of specialized experience.

Preferred Qualifications: Knowledge of NYS Medicaid program, eligibility and systems experience, and familiarity with Managed Long Term Care benefits.

Some positions may require additional credentials or a background check to verify your identity.