Job Description :
Medicaid Business Analyst
Menands, NY
24 Months
Job Description:
New York State’s Medicaid claims processing system, eMed NY, processes more than 250 million eligibility and prior authorization transactions, 470 million claims and payments in excess of $52 billion annually for New York Medicaid providers. The system supports statewide eligibility verification, claims processing and the New York Medicaid website. Additionally, the call center handles and receives nearly a million telephone calls a year from Medicaid providers, and the claims processing unit performs digital imaging and data conversion of paper documents. The critical systems, including eligibility verification, service authorization and pharmacy claims processing, are provided on a 24x7 basis. More than five million recipients receive health services through this program, with more than 75,000 participating healthcare providers providing their services, and over 8,400 system users.
Reporting to the MMIS Service Operations Team Lead this position will assist in the operation of the Claims and Financial, Provider, Client or Third-Party Liability, Subsystems of the NYS MMIS, eMedNY.
Duties include acting as ongoing liaison with the contractor, other state agencies, local districts, providers and federal representatives, and providing organizational coordination and assistance as required to facilitate the implementation of Medicaid initiatives.
The Claims Unit manages the information and decision support systems needed to make appropriate Medicaid payments for covered services, maintain reference files, and create financial reports as required by law and DOH policy as it relates to the NYS Medicaid system.
Specific responsibilities and duties will include:
work collaboratively to identify and resolve Claims and Financial, Provider, Client or Third Party Liability Subsystem problems and issues to assure that ongoing eMedNY operations are performing efficiently;
provide SME support as needed for eMedNY Claims and Financial, Provider, Client or Third Party Liability evolution initiatives;
analyze and evaluate Claims and Financial Subsystem processes and interfaces including identification of impacts and appropriate remediation enhancements;
report and provide support to eMedNY management on claims and financial issues; and, as directed, collaborate in and support the design, development and implementation of activities necessary to maintain DOH support functions with other state agencies, other federal agencies and the provider community;
work collaboratively to interpret Medicaid policy vis-à-vis systems functionality, and participate in the development of DOH Medicaid initiatives;
represent the DOH and eMedNY at seminars and training sessions as needed.
Skill Matrix:
Bachelor’s degree in a Technical field.
Experience with the Title XIX New York State Medicaid Program.
Experience with large-scale MMIS such as eMedNY, or Healthcare systems
Experience in a Medicaid environment with the interactions between Medicaid, Medicaid Managed Care, Medicare, providers and other state and federal agencies and programs.
Experience Medicaid Claims Processing.
Experience Medicaid Finance, Provider, Client or Third Party Liability.
Experience with developing and maintaining working relationships with local districts, the Medicaid provider community, other bureaus within the Office of Health Insurance Programs of the New York State Department of Health, other departments or federal agencies.
Experience working directly with PHI and PII daily in a HIPAA covered environment
Candidates should have at least 60 months experience and a majority of the following should apply:
Each candidate should fill out the months of experience they have for each item in the table:
1. Bachelor’s degree in a Technical field. #OF MONTHS 5
2. At least 60 months of experience with the Title XIX New York State Medicaid Program. #OF MONTHS 10
3. At least 60 months of experience with large-scale MMIS such as eMedNY, or Healthcare systems #OF MONTHS 10
4. At least 48 months of experience in a Medicaid environment with the interactions between Medicaid, Medicaid Managed Care, Medicare, providers and other state and federal agencies and programs. #OF MONTHS 10
5. At least 48 months of experience Medicaid Claims Processing. #OF MONTHS 20
6. At least 48 months of experience Medicaid Finance, Provider, Client or Third Party Liability. #OF MONTHS 15
7. At least 48 months of experience with developing and maintaining working relationships with local districts, the Medicaid provider community, other bureaus within the Office of Health Insurance Programs of the New York State Department of Health, other departments or federal agencies. #OF MONTHS 5
8. At least 48 months of experience working directly with PHI and PII daily in a HIPAA covered environment. #OF MONTHS 5