MEDICAID INTEGRITY SPECIALIST 3 - StateJobsNY : Job Details

The current Management Specialist 3 list has been declared appropriate to fill positions in the Medicaid Integrity Specialist 3 and Medicaid Integrity Specialist 3 (Financial Analysis) titles. To be eligible for appointment, candidates must be reachable on the OMIG promotional list for Management Specialist 3 (Albany) OR be a current New York State employee with one year of permanent or contingent-permanent service in a title eligible for transfer under Section 70.1 or 52.6 of the Civil Service Law. Duties Description The Medicaid Integrity Specialist 3 will serve as the manager over the Administrative Remedies Unit and the Enrollment Unit within the Division of Medicaid Investigations (DMI). The Administrative Remedies Unit (ARU) is responsible for conducting reviews of federal and state administrative and criminal actions involving or relating to healthcare; assessing the potential effect of those actions on the Medicaid program; and imposing sanctions as appropriate. The Enrollment Unit assists the Department of Health by conducting reviews of applications for enrollment in the Medicaid program for certain provider types delegated by OMIG.The Medicaid Integrity Specialist 3 would be responsible for: Managing two units, ARU and Enrollment, and currently three direct reports of Medicaid Integrity Specialist 2's. Maintaining working knowledge of the rules and regulations which impact enrollment and sanctions, including exclusion form Medicaid.Coordinating regularly as the primary liaison with the Department of Health, the Justice Center, and the State Education Department as it relates to interdependencies in addressing Medicaid enrollment and sanctions. Updating, drafting, and implementing templates, policies, and procedures to support consistent and efficient operations of the units. Monitoring the workflow of the units to ensure required deadlines and appropriate timelines are met. Addressing and correcting work production issues identified. Reviewing the program integrity reviews conducted by staff and ensuring appropriate OMIG actions. Signing final OMIG determination notices for public issuance. Addressing appeals resulting from OMIG actions which may include participating at Appeals Committee meetings and/or drafting affidavits related to appeals and testifying in court as necessary. Ensuring timely processing of the units' work to meet strict regulatory defined deadlines. Drafting and providing routine reports on the units' work including weekly report submissions for review by DMI Management, OMIG Executives, and the Governor's Office, and contributing to OMIG's Annual Report. Participating in regular internal and external audits of the units' work including audits by OMIG's Office of Internal Audit and Controls, the Office of the State Comptroller, and the Centers for Medicaid and Medicaid Services (CMS). Participation requires providing responses to audit questions including evidence of compliance with audit related requirements. In addition, the MIS 3 will be responsible for representing the Units at opening and exiting conferences. Representing the units on various special projects including but not limited to inter- and intra-agency projects. Current projects relate to development and revision to software systems used by the units which support unit functions. Representation requires communicating the business requirements of the units to be incorporated into system development and upgrades. Making recommendations to leadership related to cost savings initiatives, legislative, regulatory, and/or contract changes needed to support changes in the Medicaid program and/or strategic priorities, including Medicaid Redesign Team initiatives. Participating on implementation teams convened following approved recommendations. Additional Comments Submit resume and writing sample to Jenn Sichak, Office of the Medicaid Inspector General, 800 North Pearl St, 2nd FL, Albany, NY 12204, OR by email to [email protected] with a subject line of MIS 3/Enrollment-ARU, OR by fax to (518) ###-####, no later than October 27th, 2024. Some positions may require additional credentials or a background check to verify your identity.Name Jennifer Sichak Telephone 518-###-#### Fax 518-###-#### Email Address [email protected] AddressStreet 800 North Pearl Street City Albany State NY Zip Code 12204