MEDICAID CONSULTANT

NYC Department of Social Services; New York (NY); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

55a Program eligibility

Public Service Loan Forgiveness

Residency requirement support

Job summary

NYC Department of Social Services is seeking a Principal Administrative Associate II to supervise Medicaid Eligibility activities and interpret complex policies for CASA, MLTC, and related programs.

The role requires strong supervisory skills, excellent communication, and the ability to ensure accurate case processing and compliance with Federal, State, and City guidelines.

Qualifications

• Bachelor's degree or higher with related clerical/administrative experience.
• Experience interpreting Medicaid policies and procedures a plus.
• Strong supervisory and time-management abilities.

Responsibilities

• Interpret Medicaid policies for cases in CASA/MLTC/CAH programs to ensure compliant processing.
• Supervise Medicaid Eligibility Team Supervisors; manage schedules and coverage.
• Provide second-level sign-off on adverse actions and ensure proper documentation.
• Conduct random case reviews and prepare written reports with recommendations.
• Lead meetings with supervisors to address issues and provide corrective training.
• Deliver training sessions to reduce quality control errors.
• Review error reports and improve control processes for efficiency.
• Assist on high-priority actions like Tape Match and Fair Hearing.

Skills

Medicaid Knowledge

Supervisory and Interpersonal Skills

Oral and Written Communication

Word and Excel Proficiency

Timekeeping & Leave Regulations

Policy Interpretation

Education

Bachelor's degree

Associate degree

High school diploma or equivalent

Education/experience equivalency

Job description

APPLICANTS MUST BE PERMANENT IN THE PRINCIPAL ADMINISTRATIVE ASSOCIATE CIVIL SERVICE TITLE

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.

The Home Care Services Program (HCSP) is a Medicaid funded program that provides long term care to medically fragile and vulnerable individuals who require assistance with activities of daily living through the Community Alternative Systems Agency (CASA), Managed Long Term Care (MLTC) Program, the Assisted Living Program, Care at Home Program and Homebound Medicaid. The Medicaid Eligibility Unit is responsible for the Medicaid eligibility review and processing of initial applications, change actions, and renewals for all Medicaid funded long term care programs. This unit is responsible for the processing of Medicaid eligibility for consumers who receive services through one of the HCSP programs.

The Home Care Services Program (HCSP) is a Medicaid funded program that provides long term care to medically fragile and vulnerable individuals who require assistance with activities of daily living through the Community Alternative Systems Agency (CASA), Managed Long Term Care (MLTC) Program, the Assisted Living Program, Care at Home Program and Homebound Medicaid. The Medicaid Eligibility Unit is responsible for the Medicaid eligibility review and processing of initial applications, change actions, and renewals for all Medicaid funded long term care programs. This unit is responsible for the processing of Medicaid eligibility for consumers who receive services through one of the HCSP programs.

Home Care Services Program (HCSP) is recruiting for one (1) Principal Administrative Associate II, to function as a Medicaid Consultant who will:

• Interpret Medicaid policies and procedures for assigned cases for individuals applying for or in receipt of services through one of the CASA offices, the Managed Long-Term Care (MLTC) Program, the Long Term Home Health Care Program (Lombardi), Care At Home (CAH), the Assisted Living Program (ALP), and the Field Services/Homebound Unit to ensure that cases are processed in compliance with Federal, State, and City Guidelines.
• Supervise and distribute work schedules/assignments to the Medicaid Eligibility Team Supervisors, provide a timetable for efficient completion of work and ensure adequate coverage during the hours of operation.
• Provide second-level sign-off approval for all adverse case actions to ensure that the cases are properly documented, and that the appropriate processing protocols are applied.
• Conduct random review of completed cases to determine if the proper decision was made based on the documentation provided.
• Conduct meetings with Medicaid Eligibility Team Supervisors to advise on problems identified in their teams and provide written reports of meetings indicating problems found, resolution(s) initiated, and recommendations for corrective training.
• Conduct training sessions to provide Medicaid Eligibility Team Supervisors and/or Eligibility Specialists with correction and feedback based on the unit review to reduce or eliminate Quality Control errors.
• Review computer error reports, check for repetition of specific errors and follow up to determine reason for the errors. Review the control process to ensure that it is operating with maximum efficiency.
• Aid Medicaid Eligibility Team Supervisors and/or Eligibility Specialists on cases requiring resolution for high-priority actions such as Tape Match, Fair Hearing and Quality Assurance issues.

Hours/Shift: 9am - 5pm (FLEX)

PRINCIPAL ADMINISTRATIVE ASSOC - 10124

Minimum Qualifications

• A baccalaureate degree from an accredited college and two years of satisfactory full-time progressively responsible clerical/administrative experience, one year of which must have been in an administrative capacity or supervising staff performing clerical/administrative work of more than moderate difficulty; or
• An associate degree or 60 semester credits from an accredited college and three years of satisfactory full-time progressively responsible clerical/administrative experience including one year of the administrative supervisory experience described in "1" above; or
• A four-year high school diploma or its educational equivalent approved by a state’s department of education or a recognized accrediting organization and four years of satisfactory full-time progressively responsible clerical/administrative experience including one year of the administrative supervisory experience as described in "1" above; or
• Education and/or experience equivalent to "1", "2", or "3" above. However, all candidates must possess the one year of administrative or supervisory experience as described in "1" above. Education above the high school level may be substituted for the general clerical/administrative experience (but not for the one year of administrative or supervisory experience described in "1" above) at a rate of 30 semester credits from an accredited college for 6 months of experience up to a maximum of 3 year.

Preferred Skills

• Medicaid Knowledge - Strong Supervisory and Interpersonal Skills - Excellent Oral and Written Communication - Proficient in Word and Excel - Strong knowledge of City Time and Leave regulations - Ability to accurately interpret and apply Timekeeping and leave policies and procedures

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.