Medicaid Integrity Specialist 1/Trainee 1/Trainee 2

NY HELP Yes

Agency Medicaid Inspector General, NYS Office of the

Title Medicaid Integrity Specialist 1/Trainee 1/Trainee 2

Occupational Category Other Professional Careers

Salary Grade 14

Bargaining Unit PS&T - Professional, Scientific, and Technical (PEF)

Salary Range From $53764 to $66951 Annually

Employment Type Full-Time

Appointment Type Permanent

Jurisdictional Class Non-competitive Class

Travel Percentage 0%

Workweek Mon-Fri

Hours Per Week 37.5

Workday

From 8 AM

To 5 PM

Flextime allowed? No

Mandatory overtime? No

Compressed workweek allowed? No

Telecommuting allowed? Yes

County Albany

Street Address 800 North Pearl St.

City Albany

State NY

Zip Code 12204

Duties Description The Bureau of Business Intelligence, Managed Care and Data Platform Unit is recruiting to fill a Medicaid Integrity Specialist 1 Trainee positions, which will be tasked with duties related to oversight of the New York State Medicaid Managed Care Plans. These positions require that the employee gain an extensive knowledge of NYS Medicaid claims data, as well as knowledge of NYS encounter data submitted by the plans, and the systems used to submit both to the NYS Medicaid Program. The position is responsible for developing SQL algorithms to find fraud, waste, and abuse in the NYS Medicaid Data Warehouse, and potentially use other large datasets to accomplish this goal. These employees will be trained in SQL so that they may fulfill additional supporting responsibilities which would include data requests received by the Bureau of Business Intelligence.

Minimum Qualifications To be considered for appointment through NY HELPS, candidates must meet the open-competitive minimum qualifications for this position.Appointment to the Trainee 1 level requires:- Four years of experience* in the promotion of Medicaid program integrity and appropriate delivery and utilization of Medicaid programs and services; OR- Associate's degree* AND two years of experience; OR- Bachelor's degree* * Medicaid programs and services include: educating, assisting, and monitoring compliance with program regulations and obligations; developing, clarifying, and ensuring implementation of program requirements; collecting and analyzing data; evaluating and assessing appropriateness of provider or recipient participation in the Medicaid program or the appropriateness of billing or utilization of service; or developing referrals for further action or recommendations for corrective action. ** Advanced placement to the Trainee 2 or Grade 18 level may be possible depending on education and experience. It is essential that candidates clearly and concisely indicate exactly how they meet the above minimum qualifications in their resume. Failure to show how you meet the minimum qualifications above may result in disqualifications and removal from consideration. *Your degree must have been awarded by a college or university accredited by regional, national, or specialized agency recognized as an accredited agency by the U.S. Department of Education/U.S. Secretary of Education. If your degree was awarded by an educational institution outside of the United States or its territories, you must provide independent verification of equivalency. This information can be found at Candidates are responsible for the evaluation fee. Competitive Minimum Qualifications: Current New York State Employee with one year or more of permanent or contingent-permanent competitive service, or 55 b/c service as a Medicaid Integrity Specialist 1; OR current New York State Employee with one year or more of permanent or contingent-permanent service or 55 b/c service in a qualifying title and eligible for transfer under Section 70.1, 70.4, or 52.6 of the Civil Service Law.

Additional Comments Permanent, Full-Time, Competitive (for transfer and appointments off a list), Non-Competitive (for appointments through the NY HELPS Program). Trainee 1 salary: 53,764Trainee 2 salary: 59,994G-18 salary: 66,951SALARIES ARE NON-NEGOTIABLE.**The Department of Civil Service has developed the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS), which is a streamlined program that allows appointment to this title and others without examination. For the duration of the NY HELPS program, this title, may be filled via permanent, non-competitive appointment, which means no examination is required but all candidates must meet the minimum qualifications of the titles for which they apply.Telecommuting is permitted up to 50% each pay cycle, which is 2 weeks. Full time in office attendance is required for at least the first 6 weeks, and Telecommuting time will be increased progressively up to the maximum allowable 50%.

Some positions may require additional credentials or a background check to verify your identity.

Name Tess M.

Telephone

Fax

Email Address [email protected]

Address

Street 800 North Pearl St.

City Albany

State NY

Zip Code 12204

Notes on Applying Submit resume and official college transcript(s) to Tess M. by email to [email protected] with a subject line of MIS 1 - BBI, no later than 3/25/26.PLEASE NOTE: We are unable to open documents from Google Docs, Google Drive, OneDrive, Apple Pages, and/or "the cloud". Please submit resume as a Word or PDF attachment.OMIG does not participate in E-Verify and does not sponsor visa applications.The Office of the Medicaid Inspector General is proud to be an equal opportunity employer. We encourage those with unique backgrounds and contributions such as education, culture, ethnicity, race, sex, gender identity and expression, nation of origin, age, languages spoken, veteran's status, color, religion, disability, sexual orientation, and beliefs to apply. We provide reasonable and religious accommodations for any part of the application and hiring process. If you have a disability or special need that requires accommodation, please send a request to [email protected] #31518, 00527