Program Research Specialist 4 (Health Care Finance) (NY HELPS) - 63299

About the role

The incumbent will perform research, evaluation, and analytical studies relating to the Partial Capitation, Medicaid Advantage Plus, and Program of All-inclusive Care for the Elderly Managed Long Term Care Programs.

Responsibilities

• Direct and supervise reimbursement mechanisms including capitation rate setting, directed payments, payment reconciliations, quality awards, and enhanced FMAP funding.
• Develop, implement, and review funding methodologies incorporating price and utilization metrics, fee-for-service rate schedules, health plan encounter data, community health assessment data, plan cost reports, and data surveys in accordance with State and Federal statutory regulations and actuarial principles.
• Review and report on rate schedules prepared by the contracted actuary for actuarial soundness and generally accepted accounting principles.
• Act as the subject matter resource for the bureau on data analytics software programs, including newly adopted tools, to develop actionable analytical reports supporting data-driven decision making.
• Conduct programmatic discussions and research with OHIP contract staff and DOB examiners; provide written directives outlining long-term care objectives, including integrated care, personal care utilization cost containment, worker wage compliance, and Medicaid standards of eligibility for access to Managed Long Term Care.
• Analyze budget scorecard proposals and present budget briefings to the Division of Budget/Chamber.
• Lead studies and review compliance with objectives; coordinate with stakeholders such as the State’s certifying actuary, home care provider associations, health plan associations, other State agencies (OMH and OASAS), and the Centers for Medicare and Medicaid Services at the Federal level to ensure finance and regulatory compliance.

Requirements

Minimum Qualifications

• Reassignment: Current NYS Department of Health (DOH) employee with permanent or contingent permanent status as a Program Research Specialist 4 Health Care Finance, G-27.
• Permanent Transfer Candidates: Current NYS employee with one year of permanent or contingent permanent competitive service in a title eligible for transfer under Section 52.6 of the Civil Service Law. The transfer cannot be a second consecutive transfer resulting in an advancement of more than two salary grades.
• NY HELPS Non-Competitive Minimum Qualifications: Twelve semester credit hours in statistics, biostatistics, economics, econometrics, research methods, mathematics, data analysis, or data modeling AND five years of professional research experience in the collection and evaluation of quantitative data directed toward review and analysis of healthcare reimbursement mechanisms, funding methodology, health economics, healthcare financing, cost containment, or patient classification systems. Two years of the experience must have involved supervision of professional staff engaged in these functions.

Preferred Qualifications

• Knowledge of NYS Medicaid program in the Managed Long Term Care (MLTC) environment, including program and financial structure of the Partial Capitation, PACE, and MAP programs.
• Understanding of MLTC financing and rate-setting methodologies, including knowledge of minimum wage and other health worker wage adjustments, shifting MLTC reimbursement mechanisms, service utilization dynamics in NYS Medicaid, Managed Care Organization (MCO) tax structure, financial reporting structure, directed payments, quality incentives awards and withholds, and their related data sources.
• Knowledge of actuarial financing principles and standards of practice, federal managed care rate-setting regulations, and understanding of the financial and rate impact of population acuity and the managed care risk adjustment process.

Benefits

We offer a work-life balance and a generous benefits package, worth 65% of salary, including:

• Holiday & Paid Time Off
• Public Service Loan Forgiveness (PSLF)
• Pension from New York State Employees’ Retirement System
• Shift & Geographic pay differentials
• Affordable Health Care options
• Family dental and vision benefits at no additional cost
• NYS Deferred Compensation plan
• Access to NY 529 and NY ABLE College Savings Programs, and U.S. Savings Bonds

And many more...

Pay

For new State employees appointed to graded positions, the annual salary is the hiring rate (beginning of the Salary Range) of the position. Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations, and negotiated union contracts.