MEDICAID ELIGIBILITY SPECIALIST

HRA/DEPT OF SOCIAL SERVICES; New York (NY); On-site; USD 44,000 - 50,000; Full time

Job summary

HRA/DEPT OF SOCIAL SERVICES in New York City seeks Medicaid Eligibility Specialists to review applications and renewals for Home Care Services, using WMS and external systems to determine eligibility decisions. The role requires evaluating documentation and ensuring timely processing.

Ideal candidates have related education/experience and demonstrate critical thinking, organization, and attention to detail, with residency in NYC preferred.

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 related work; or
• A satisfactory combination of education and/or experience equivalent to the above.

Responsibilities

• Review Medicaid applications and renewals for consumers applying for or receiving Home Care Services.
• Complete required case actions using WMS and external systems (EDITS Plus, HRA One Viewer, eMedNY).
• Determine if additional documentation or referrals to outside agencies are needed to make eligibility decisions.
• Consult with the Unit Supervisor on complex cases to ensure timely completion within strict timeframes.

Skills

Medicaid eligibility

Critical thinking

Detail oriented

Education

Some college credits

High school diploma + 1 year experience

Education/experience equivalency

Job description

APPLICANTS MUST BE PERMANENT IN THE ELIGIBILITY SPECIALIST CIVIL SERVICE TITLE.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.

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 Service Program Medicaid Eligibility Unit is recruiting six (6) Medicaid Eligibility Specialists who will:

• Review Medicaid applications and renewals for consumers applying for, or in receipt of Home Care Services. Review documentations for completeness and adequacy to make the appropriate eligibility decision, using the applicable NYC, NYS and Federal guidelines and procedures.
• Complete the required case action utilizing the Welfare Management System (WMS) and various external program applications, such as the Eligibility Data Image Transfer System (EDITS) Plus, the HRA One Viewer and eMedNY and complete the requisite consumer notices, forms, and system updates.
• Determine whether additional documentations are required or referrals to an outside agency is necessary, to make an eligibility decision.
• Consult with the Unit’s Supervisor, as needed, on overall problems and complicated cases to ensure timely completion of work within strictly enforced timeframes.

Salary Range: $43,866 - $50,446

ELIGIBILITY SPECIALIST - 10104

Minimum Qualifications

1. Completion of 30 semester credits at an accredited college or university; or
2. 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;
3. 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

• Ability to review and identify case data that is necessary to perform basic mathematical computations to determine Medicaid Eligibility.
• Ability to use critical thinking.
• Organized / Detailed oriented.

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.