Source: New York State Jobs · Bespree is not the employer.
Within the Division of Eligibility and Marketplace Integration, the Bureau of Quality Management and Change Control (QMCC) oversees NY State of Health contact center operations and manages the change control process with the contractor, working with other bureaus to assess the impact of proposed changes, identify impacts across program areas, and track all change requests.
QMCC also monitors the quality of the contractor’s performance by conducting quality assurance reviews designed to identify trends and provide recommendations for improvement.
Under the general supervision of higher-level staff, the MAS 1 incumbents will assist with the execution of QMCC’s objectives geared toward ensuring quality customer service at the NY State of Health contact center.
Specific duties include but are not limited to: provide supervision to paraprofessional staff; field electronic referrals from the contact center; work with appropriate staff to resolve consumer issues; conduct quality (QA) reviews of recorded consumer calls and document processing using established QA procedures; maintain cooperative working relationships with other units, division, departments, and agencies to facilitate the delivery of public health insurance.
Reassignment: Current NYS Department of Health (DOH) employee with permanent or contingent-permanent status as a Medical Assistance Specialist 1, G-18.
Transfer: 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 1, G-18.
Six years of experience developing public or private health related policy; analyzing AND interpreting public or private health related policy to assist consumers; determining or reviewing financial eligibility for healthcare or consumer-assisted programs to ensure individuals meet eligibility criteria specified in State and/or federal laws, rules, and regulations; 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; AND/OR conducting independent examinations of health care facilities or program integrity reviews of health care programs to ensure compliance with laws, rules, and regulations.
Substitution: An associate degree can substitute for two years of specialized experience; a bachelor’s degree can substitute for four years of experience; a master’s degree in a related field can substitute for five years of experience; and a doctorate in a related field can substitute for six years of experience.
Preferred Qualifications: Preferred candidates will have professional experience in public health insurance programs, including New York’s Medicaid, and/or Child Health Plus.
Preferred candidates will also have excellent verbal and written communication skills; strong analytical skills and attention to detail; strong organizational skills; proficiency in Microsoft Office (Word, Excel, Access); the ability to work well independently and as part of a team, and to manage multiple priorities in order to meet deadlines; experience using electronic data systems, such as eMedNY and NYSOH Back Office; and supervisory experience.
When reviewing qualifications, omissions and vagueness cannot be interpreted in the candidate’s favor. Candidates are responsible for providing accurate and clear descriptions of their experience demonstrating how they meet the minimum qualifications.
This position is part of the NYS HELPS program. No examination is required.
We offer a work-life balance and a generous benefits package, worth 65% of salary, including:
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
If you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone 518-486-1812 or email doh.sm.reasonable.accommodation@health.ny.gov to make a request.
NYS Department of Health does not participate in E-Verify and does not sponsor visa applications.
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.
New York State agencies, departments, and public authorities provide services across healthcare, engineering, administration, public safety, the trades, and other areas.
Source: New York State Jobs · Bespree is not the employer.
Within the Division of Eligibility and Marketplace Integration, the Bureau of Quality Management and Change Control (QMCC) oversees NY State of Health contact center operations and manages the change control process with the contractor, working with other bureaus to assess the impact of proposed changes, identify impacts across program areas, and track all change requests.
QMCC also monitors the quality of the contractor’s performance by conducting quality assurance reviews designed to identify trends and provide recommendations for improvement.
Under the general supervision of higher-level staff, the MAS 1 incumbents will assist with the execution of QMCC’s objectives geared toward ensuring quality customer service at the NY State of Health contact center.
Specific duties include but are not limited to: provide supervision to paraprofessional staff; field electronic referrals from the contact center; work with appropriate staff to resolve consumer issues; conduct quality (QA) reviews of recorded consumer calls and document processing using established QA procedures; maintain cooperative working relationships with other units, division, departments, and agencies to facilitate the delivery of public health insurance.
Reassignment: Current NYS Department of Health (DOH) employee with permanent or contingent-permanent status as a Medical Assistance Specialist 1, G-18.
Transfer: 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 1, G-18.
Six years of experience developing public or private health related policy; analyzing AND interpreting public or private health related policy to assist consumers; determining or reviewing financial eligibility for healthcare or consumer-assisted programs to ensure individuals meet eligibility criteria specified in State and/or federal laws, rules, and regulations; 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; AND/OR conducting independent examinations of health care facilities or program integrity reviews of health care programs to ensure compliance with laws, rules, and regulations.
Substitution: An associate degree can substitute for two years of specialized experience; a bachelor’s degree can substitute for four years of experience; a master’s degree in a related field can substitute for five years of experience; and a doctorate in a related field can substitute for six years of experience.
Preferred Qualifications: Preferred candidates will have professional experience in public health insurance programs, including New York’s Medicaid, and/or Child Health Plus.
Preferred candidates will also have excellent verbal and written communication skills; strong analytical skills and attention to detail; strong organizational skills; proficiency in Microsoft Office (Word, Excel, Access); the ability to work well independently and as part of a team, and to manage multiple priorities in order to meet deadlines; experience using electronic data systems, such as eMedNY and NYSOH Back Office; and supervisory experience.
When reviewing qualifications, omissions and vagueness cannot be interpreted in the candidate’s favor. Candidates are responsible for providing accurate and clear descriptions of their experience demonstrating how they meet the minimum qualifications.
This position is part of the NYS HELPS program. No examination is required.
We offer a work-life balance and a generous benefits package, worth 65% of salary, including:
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
If you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone 518-486-1812 or email doh.sm.reasonable.accommodation@health.ny.gov to make a request.
NYS Department of Health does not participate in E-Verify and does not sponsor visa applications.
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.
New York State agencies, departments, and public authorities provide services across healthcare, engineering, administration, public safety, the trades, and other areas.