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New York State Department of Health · 1 day ago

Eligibility Program Manager 1 (NY HELPS) - 79342

Buffalo, NY

Full-time

Onsite

Senior Level, Lead/Staff

$107K/yr - $132K/yr

8+ years exp

The New York State Department of Health oversees health-related programs and is seeking an Eligibility Program Manager 1 to manage contact center operations and ensure quality customer service. The role involves oversight of staff, monitoring performance, and executing the Bureau's objectives related to health insurance eligibility and quality assurance.

Health Care

Work & Life Balance

No H1B

Responsibilities

Overseeing and directing staff in determining eligibility for a health insurance program or consumer assisted program in which financial eligibility criteria must be met

Overseeing and directing staff in performing utilization review, including prepayment or post-payment review of requested health care services, prior approval or authorization activities, adjudication or pricing of claims for payment, or analysis of patterns of health care

Overseeing and directing staff in developing mechanisms for the reimbursement and financing of health care services, including rate-setting or approval, capitation reimbursement methodologies, fee schedule development, coding constructs for medical goods and services, or application and processing of reimbursement methodologies

Administering and overseeing staff responsible for day-to-day program operations for budgeting, staffing, or program planning

Overseeing and directing staff in inspecting, assessing, or monitoring health insurance programs or health care facilities for certification, licensure, or adherence to laws, rules, regulations, and policies

Overseeing and directing staff in planning, designing, developing, researching, or evaluating proposals to establish or refine health related programs, with responsibility for interpreting legislation or regulations, defining and describing target populations and local demographics, grant and proposal writing, or developing, reviewing, and evaluating contracts

Administering and overseeing staff responsible for performing quality assurance activities such as ensuring compliance with laws, rules, regulations, and policies, as it pertains to activities 1 through 6

Qualification

Public health insurance programsQuality assurance activitiesSupervisory experienceMicrosoft OfficeAnalytical skillsManaging multiple prioritiesEMedNYNYSOH Back OfficeVerbal communicationWritten communicationOrganizational skillsTeamworkAttention to detail

Required

Current NYS Department of Health employee with permanent or contingent permanent status as a Eligibility Program Manager 1, G-27

New York State employee with one or more years of permanent or contingent-permanent service in title at Grade 25 or above, and eligible for transfer to Eligibility Program Manager 1, G-27, under section 70.1 or 52.6 of the Civil Service Law

Eight years of professional experience, two years of which must have included second-level supervision of staff, performing one or more of the following seven activities in a program with one or more of the following functions: provides reimbursements for health care services; works with social services program areas; determines eligibility for a consumer assisted program in a hospital or other health care facility; provides health care regulatory oversight; or performs quality assurance and interpretation/application of standards of health care

A Bachelor's Degree can substitute for four years of experience; a Master's Degree can substitute for five years of experience