Job Description

If you are hired provisionally in this title, you must take and pass the Civil Service Exam, when it
becomes available, to be eligible for continued employment.

Under supervision of the Ombudsman Unit Supervisor within the Medicaid Eligibility Information Services, with some latitude for independent initiative and judgment, the Medicaid Eligibility Specialist is responsible for interviewing Medicaid applicants and reviewing their documentation to determine eligibility for Medicaid.

The Office of Constituent Services (OCS) is seeking (1) Eligibility Specialist II to function as Case Reviewer.

The Case Reviewer will:

- Respond to inbound and outbound telephone calls received from clients and/or authorized
representatives with inquiries related to Medicaid coverage including possible questions related
to the Excess Income Program or the A/Rs responsibility towards the cost of their care (NAMI-Net
Available Monthly Income) if institutionalized.

- Interview and/or review documentation submitted by applicants/recipients (A/R) or authorized
representatives, to determine eligibility for Medicaid.

- Conduct a comprehensive review of applications including financial and legal documentation, as
well as paid or unpaid medical bills submitted by A/R and/or authorized representative

- Determine eligibility for the appropriate level of Medicaid coverage for MAGI and Non-MAGI A/Rs.

- Assist consumers who need further assistance in understanding the eligibility criteria to qualify for
the Excess Income Program.

- Prepare eligibility forms and notices to inform A/Rs of case disposition.

- Prepare daily activity logs of cases completed for submission to the supervisor.

Work Location:
92-31 Union Hall Street, Jamaica, NY 11433

Hours/Shift:
M-F, 11:00am-7:00pm (Straight Time) No Flextime Available

Qualifications

1. Completion of 30 semester credits at an accredited college or university; or
2. A four high school diploma or its educational equivalent and one year of full-time satisfactory experience in one or more of the following areas; performing the work described below:
a. Interviewing, gathering information and/or preparing necessary documentation for the purpose of making recommendations concerning eligibility for public assistance or unemployment, health benefits, social security, insurance, or participation in social services or community programs, and other similar benefits; or
b. Performing bookkeeping, bank teller duties, housing office teller duties, purchasing agent, assistant store manager, sales representative responsible for accounts, or customer service duties or a job in which the duties include helping customers with questions or concerns; or
c. Dealing with social service agencies, legal representatives, or aiding individuals in navigating housing, social, financial or health problems or application systems; or
3. A satisfactory combination of education and/or experience equivalent to "1" or "2" above. College education may be substituted for the experience in "2" above on the basis that 30 semester credits from an accredited college or university may be substituted for each year of required experience. However, all candidates must have at least a four year high school diploma or its educational equivalent.
Special Note
Work experience which provides only incidental opportunities to perform the job duties as described in "2a", "2b" and "2c" above are not acceptable for meeting the minimum qualification requirements.