Medicaid Integrity Specialist 1/Trainee 1/Trainee 2

About the role

This position is in the Bureau of Quality Control and Enterprise Projects, Quality Assurance unit, which ensures all agency documentation and reporting are thorough, accurate, and consistent. The role is a permanent, full‑time position; appointments may be made competitively (for transfer or off a list) or non‑competitively through the NY HELPS program, which allows appointment without examination provided candidates meet the minimum qualifications. The Department of Civil Service has developed the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS), 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, meaning no examination is required but all candidates must meet the minimum qualifications.

Responsibilities

• Work closely with the Quality Assurance unit supervisor and/or manager on all projects and duties.
• Review and assess current agency processes and procedures, particularly those related to reporting and tabulating agency statistics and data.
• Assist with the creation, management, and publishing of required agency reports, including Annual Report, Quarterly Accountability Statement, and any other ad hoc reports required of the agency.
• Compile, evaluate, and monitor pertinent agency statistics and data for use in required reports.
• Assist with the review of audit protocols for accuracy and consistency.
• Participate in agency-wide data workgroups.
• Other projects and duties as assigned.

Qualifications

Minimum Qualifications (for appointment through NY HELPS):

• 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. Candidates must clearly indicate how they meet the minimum qualifications in their resume; failure to do so may result in disqualification.

Degrees must be awarded by a college or university accredited by a regional, national, or specialized agency recognized by the U.S. Department of Education/U.S. Secretary of Education. If the degree was awarded outside the United States or its territories, independent verification of equivalency is required (see NY CS degree equivalency page); candidates are responsible for the evaluation fee.

Competitive Minimum Qualifications (for current NY State employees):

• 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