NY HELP Yes Agency Medicaid Inspector General, NYS Office of the Title Medicaid Integrity Specialist 1/Trainee 1/Trainee 2 NY HELPS Occupational Category No Preference Salary Grade 18 Bargaining Unit PS&T - Professional, Scientific, and Technical (PEF) Salary Range From $65001 to $82656 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? Yes Telecommuting allowed? Yes County Albany Street Address 800 North Pearl St City Albany State NY Zip Code 12204 Duties Description The Division of Medicaid Investigations (DMI) ensures the integrity of the Medicaid program by conducting investigations, recovering over payments, and implementing administrative sanctions against providers and recipients. The incumbent of this position will work with the Recipient Restriction Program (RRP) within DMI. The RRP reviews recipients who overutilize or abuse their Medicaid Benefit and restricts them to primary providers to coordinate their care and control unnecessary costs.This position will perform tasks related to the Recipient Restriction Program (RRP) Upstate, Downstate, Medicaid Managed Care, and the Health Benefit Exchange (HBE). This position will be responsible for ensuring that the RRP continues to run smoothly, and duties will include, but not be limited to:• Creating recipient folders and medical interfiles needed for review by the State Medical Review Team (SMRT).• Maintaining databases weekly via the validation report and manual updates.• Completing the following monthly reports: restriction continuation reports, cost savings calculations, and restriction lift list.• Maintaining and loading Drug Utilization Review (DUR) and Bureau of Medicaid Fraud Allegations (BMFA) cases into tracking database.• Performing restriction lifts requested by Medicaid Managed Care Organizations (MMCOs).• Assisting with audit requests.• Communicating with other agencies, MMCO's, Local Departments of Social Services (LDSS), and other divisions within OMIG regarding tracking and coordination of restrictions.• Answering communications from the RRP Hotline, shared email account, and/or shared HCS account. PREFERRED QUALIFICATIONS: Excellent verbal and written communication skills with the ability to work independently and as part of a team. Proficient in Microsoft Office Suite and the ability to learn new data systems. Knowledge of the Medicaid program and/or health insurance programs. Minimum Qualifications This title is part of the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS)**To be considered for appointment through NY HELPS, candidates must meet the open-competitive minimum qualifications for this position: • Bachelor’s degree* or higher• Advanced placement to the Trainee 2 or Grade 18 level may be possible depending on education and experience. *Your degree must have been awarded by a college or university accredited by a 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 http://www.cs.ny.gov/jobseeker/degrees.cfm. 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. 70.1 Transfer: • For a 70.1 transfer to this title, you must have one year of permanent or contingent-permanent competitive service in a 70.1 title allocated to a salary grade 16 or above (11 or above for a Trainee 1, 12 or above for a Trainee 2).70.4 Transfer:• For a 70.4 transfer to this title, your current title must be within two salary grades, and either be on the PCO or be on the PATT and possess a bachelor’s degree. Your score on either the PCO or PATT does not need to be reachable. 52.6 Transfer: • For a 52.6 transfer to this title, you must have one year of permanent or contingent-permanent service in a 52.6 title allocated to a salary grade 16 or above (11 or above for a Trainee 1, 12 or above for a Trainee 2).To determine if your current Civil Service title is eligible for transfer to this title, visit the Career Mobility GOT-IT website: Career Mobility Office » GOT-IT (ny.gov)Appointments via transfer must not result in a second, consecutive transfer with an advancement of more than two S-grades or one M-grade.55-b/c program appointments: For a 55 b/c appointment, you must: • Possess the minimum qualifications for the selected title as established by the Department of Civil Service and listed on the most recent exam announcement. • Meet the applicable minimal mental and/or physical requirements for the job (with a reasonable accommodation if necessary). • Have a current Eligibility Letter from the NYS Department of Civil Service, www.cs.ny.gov/rp55/ and be able to provide it to the Human Resources Office upon request.*If you are currently 55 b/c eligible and possess a bachelor’s degree, we encourage you to apply for this position.**Depending on qualifications, you may be required to serve a 1 or 2-year traineeship that leads to the full level grade 18 position. Additional Comments Permanent, Full-Time, Competitive (for transfers and appointments off a list), Non-Competitive (for appointments through the NY HELPS Program). Trainee 1 salary starts at $49,363. Salary is 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. Some positions may require additional credentials or a background check to verify your identity. Name Jenn Sichak Telephone Fax Email Address Recruitment@omig.ny.gov Address Street 800 North Pearl St 2nd Floor City Albany State NY Zip Code 12204 Notes on Applying Submit resume to Jenn Sichak, Office of the Medicaid Inspector General, 800 North Pearl St, 2nd Floor, Albany, NY 12204, OR by email to Recruitment@omig.ny.gov with a subject line of MIS 1/RRP, OR by fax to (518) 408-0395, no later than February 23rd, 2025.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.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 RARequest@omig.ny.gov.