Medicaid Integrity Specialist 1/Trainee 1/Trainee 2 (...

Job Title This position is needed to assist the Division of System Utilization & Review with numerous tasks within the division. This role will assist with audit support as well as general administrative support. The duties include, but are not limited to the following: Prepares narrative reports or draft correspondence to providers, legal representatives, or other stakeholders outlining deficiencies and proposed corrective action(s); monitors compliance with plans of action. Assist with the review of DARs/FARs. Review templates for errors and work with supervisors for any template changes that are needed. Assist managers with creating spreadsheets for the division that will be used for weekly, monthly, quarterly, and yearly reports. Assist in opening audits in FACTS for both RAC and TPL. Assist with vetting providers. Reach out to other divisions for clearance requests, update auditor with findings, and update SharePoint with responses. Review of transition documentation from the contractors. Review final audit files to verify that all documents have been received, and authorizations for voiding have been signed and submitted. Ad hoc requests from staff, managers, and directors. Reviews documents for quality and consistency, ensuring compliance with applicable laws, rules, or regulations: review of transition documents from providers, Ad hoc request, opening audits in FACTs. Provides technical assistance and support to agency staff, providers, and other stakeholders through setting up interviews for DSUR, following up on evaluations and maintaining files for entire division. Follow up on late evaluations and maintain the files for the entire division. Performs ancillary duties in support of audits, investigations, and other program integrity activities through FOIL request, vetting providers, SGS & OSC request. Seating Requests for DSUR. Work with Operations for requests through the seating portal, and update management with any changes. As needed, order & maintain Supplies. Answer the main phone line. Review and distribute mail. Minimum Qualifications General Public: 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 experiencein the promotion of Medicaid program integrity and appropriate delivery and utilization of Medicaid programs and services; OR Associate's degreeAND 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. 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. Preferred Qualifications: Works well as part of a team and independently; demonstrates strong critical thinking skills, ability to multitask, attention to detail, and excellent interpersonal skills. Excellent written and oral communication, including grammar and editing skills; critical, independent thinking, and analytical skills; excellent reading comprehension. Proficiency with Microsoft Office Suite and ability to learn new data systems. Salaries 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. Note on telecommuting: OMIG employees may be approved for a maximum of 50% telecommuting, however, they are required to apply and obtain approval through management in accordance with OMIG's Telecommuting Program Guidelines.

Created: 2026-03-04