Medical Assistance Specialist 2 (NY HELPS) - 61609, 61610

Minimum Qualifications

Current Department of Health (DOH) employee with permanent or contingent-permanent status as a Medical Assistance Specialist 2; OR current NYS employee with one year or more of permanent or contingent-permanent, competitive service in a title eligible to transfer under Section 52.6 or Section 70.1 of the Civil Service Law to a Medical Assistance Specialist 2

Non-competitive HELPS

Seven years of professional experience performing one or more of the following activities in a health care facility, health care agency, health care delivery system, Medicaid program, and/or other public or private health insurance program: establishing, revising, and/or assisting with the implementation of program policies and procedures to meet treatment and/or regulatory requirements of health care; analyzing State and/or federal health insurance laws to inform the development or modification of program operations; determining financial eligibility for enrollment in public or private health insurance plans or government funded health services programs; establishing mechanisms for the reimbursement and financing of health care services, including rate-setting, development of capitation reimbursement methodologies, and development of fee schedules; performing utilization review of requests for medical treatment including prior approval or authorization activities, adjudication of claims for payment and/or provider credentialing; conducting independent examinations of health care facilities or program integrity reviews of health care programs to ensure compliance with laws, rules, and regulations.

An associate degree may substitute for up to two years of the experience; bachelor’s degree may substitute for up to four years.

Preferred Qualifications: Critical thinking skills, analytical skills with Microsoft Excel, ability to solve problems independently. Professional work experience and/or education in accounting and trend analyses.

Duties Description

This incumbent will function as a financial unit lead within the Division of Finance and Rate Setting, within the Bureau of Financially Distressed Hospitals (FDH).

The Bureau of Financially Distressed Hospitals Bureau’s goal is to promote financial sustainability for healthcare providers, thereby improving health service quality, preserving access, and decreasing statewide provider reliance on State aid to fund operations. In addition, this Bureau works directly with hospitals on their cash flow, hospital needs, and various payment mechanisms, including Directed Payment Templates (DPT), Vital Access Program (VAP) funding, and Vital Access Provider Assurance Program (VAPAP) awards.

Duties Include

Organize hospital data to determine hospital financial allocation plans and develop funding options; Establish hospital metrics for demonstrating improvement, and monitoring data reported against those metrics; Manage a distressed hospital dashboard to ensure an accurate and complete view of hospital submitted data elements.

Oversee the monitoring and oversight of hospital metrics and financial management of funding allocations; Facilitate the integration of hospital reporting with other Medicaid and Department of Health data to assess regional and/or hospital specific trends as well population health activities; Review FDH applications and financial sustainability plans.

Build automated reports in Tableau that organize FDH information (cash flows, revenues, expenses, utilization, etc.) to translate data into meaningful reports that can assist stakeholders in transformation planning purposes; Provide policy expertise to FDH Units by reviewing proposed changes to distressed hospital policies and procedures, and by ensuring changes are consistent with program goals and requirements; Interprets and clarifies FDH policies, procedures, and requirements for lower-level staff, outside parties, and department contractors; Reviews legislative proposals and regulatory amendments and determines their impact on FDH operations; Advises higher-level staff of impact on distressed hospital operations, and proposes changes based on program expertise; Oversees applications for FDH funding plans and programs; Oversees quality assurance FDH activities for staff and contractors, participates in meetings with contractors to ensure consistent application of quality assurance guidelines; Provides training to lower-level staff, department contractors, and providers regarding regulatory requirements and FDH program operations; Supervises a Unit of Medical Assistance Specialists 1.

Additional Comments

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...

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.

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