AID TO CONTINUE AND COMPLIANCE WORKER

City of New York; New York (NY); On-site; USD 60,000 - 75,000; Full time

Job summary

HRA/DSS NYC is seeking an Eligibility Specialist, Level II to serve as an Aid to Continue Compliance Worker. The role involves reviewing Fair Hearing decisions, verifying eligibility status, recalculating budgets, and ensuring timely case actions in alignment with state regulations.

The position requires strong knowledge of Medicaid eligibility processes, experience with WMS/eMedNY, and the ability to work under deadlines. Residency in NYC is typically required.

Qualifications

• Bachelor-level education or higher not required if experience meets the qualification.
• Formal education requirements include 30 college credits or a high school diploma with relevant work experience.
• Experience in public assistance, unemployment benefits, health benefits or social services is acceptable in lieu of college credits.

Responsibilities

• Review and analyze Fair Hearing decisions to determine actions needed to reopen or restore cases.
• Verify case information using WMS, eMedNY, and FHIS to determine eligibility status and monitor deadlines.
• Recalculate budgets to restore benefits when required based on Fair Hearing outcomes.
• Respond to inquiries from supervisors and provide case status updates.
• Provide information regarding PHD eligibility and ensure compliance with state regulations.

Skills

Medicaid eligibility

Medicaid Savings Program

Communication

Interviewing

Time management

Organization

Independent starter

WMS actions

EmedNY

Education

30 semester credits

High school diploma or GED

Tools

WMS

eMedNY

FHIS

Word

Excel

Job description

APPLICANTS MUST BE PERMANENT IN ELIGIBILITY SPECIALIST CIVIL SERVICE TITLE OR IF YOU ARE HIRED PROVISIONALLY IN THIS TITLE, YOU MUST TAKE AND PASS THE CIVIL SERVICE EXAM, WHEN IT BECOMES AVAILABLE, TO BE ELIGIBLE FOR CONTINUED EMPLOYMENT. The Department of Social Services (DSS) is comprised of the administrative units of the New York City Human Resources Administration (HRA) and the Department of Homeless Services (DHS). HRA is dedicated to fighting poverty and income inequality by providing New Yorkers in need with essential benefits such as Food Assistance and Emergency Rental Assistance. DHS is committed to preventing and addressing homelessness in New York City by employing a variety of innovative strategies to help families and individuals successfully exit shelter and return to self-sufficiency as quickly as possible. DSS/HRA Fair Hearing Administration is responsible for providing representation of the Agency at NYS Administrative Hearings in the following program areas: Cash Assistance (CA), Supplemental Nutrition Assistance Program (SNAP), IREA, HASA and MISCA – Medical Assistance (MA).

The Office of the General Counsel / Fair Hearing Administration is recruiting for one (1) Eligibility Specialist, Level II to function as Aid to Continue Compliance Worker who will:

• Review and Analyzes Fair Hearing decisions and directives issued by the State, to determine the correct action needed, to restore or reopen cases based on the FH directive.
• Verify case information using WMS, eMedNY and FHIS to determine eligibility status, and monitor progress to ensure compliance deadlines are met.
• Recalculate budgets to restore benefits when required to reopen or adjust cases based on Fair Hearing outcome.
• Respond to inquiries from supervisors, provide case status or updates on action taken, identify errors and ensure corrections are made.
• Provide information regarding PHD eligibility and ensures all actions follow State regulations, Medicaid eligibility rules and Fair Hearing policies.

Hours/Shift: 9am - 5pm

ELIGIBILITY SPECIALIST - 10104

Minimum Qualifications

• Completion of 30 semester credits at an accredited college or university; or
• A four high school diploma or its educational equivalent and one year of full-time satisfactory experience in one or more of the following areas; performing the work described below: a. Interviewing, gathering information and/or preparing necessary documentation for the purpose of making recommendations concerning eligibility for public assistance or unemployment, health benefits, social security, insurance, or participation in social services or community programs, and other similar benefits; or b. Performing bookkeeping, bank teller duties, housing office teller duties, purchasing agent, assistant store manager, sales representative responsible for accounts, or customer service duties or a job in which the duties include helping customers with questions or concerns; or c. Dealing with social service agencies, legal representatives, or aiding individuals in navigating housing, social, financial or health problems or application systems; or
• A satisfactory combination of education and/or experience equivalent to "1" or "2" above. College education may be substituted for the experience in "2" above on the basis that 30 semester credits from an accredited college or university may be substituted for each year of required experience. However, all candidates must have at least a four year high school diploma or its educational equivalent.

Special Note Work experience which provides only incidental opportunities to perform the job duties as described in "2a", "2b" and "2c" above are not acceptable for meeting the minimum qualification requirements.

Preferred Skills

• Must have extensive background in Medicaid eligibility and be able to complete all MA eligibility transactions in WMS.
• Must be up to date in Medicaid Savings Program and how to accrete a case in the EmedNY system.
• Must be able to communicate well with all consumers and act in a professional manner even when confronted with difficult consumers.
• Must be able to move the interviews along to allow to meet the deadlines imposed by the State OTDA.
• Work well under pressure, as well as, manage the interview process.
• Must be organized, self-sufficient and be an independent starter.
• The worker must be proficient in WMS eligibility actions, understand all budgeting types, understand Edits, Emedny and proficient in working with Word and Excel reports.

55a Program

This position is also open to qualified persons with a disability who are eligible for the 55-a Program. Please indicate at the top of your resume and cover letter that you would like to be considered for the position through the 55-a Program.

Public Service Loan Forgiveness

As a prospective employee of the City of New York, you may be eligible for federal loan forgiveness programs and state repayment assistance programs. For more information, please visit the U.S. Department of Education’s website at https://studentaid.gov/pslf/.

Residency Requirement

New York City residency is generally required within 90 days of appointment. However, City Employees in certain titles who have worked for the City for 2 continuous years may also be eligible to reside in Nassau, Suffolk, Putnam, Westchester, Rockland, or Orange County. To determine if the residency requirement applies to you, please discuss with the agency representative at the time of interview.

Additional Information

The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.