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Is this a Project or Program specific request (e.g., Connections, SFS)?
If yes, please list the Project or Program Name:
Please provide a short description of the project:
New York State's Medicaid claims processing system, eMedNY,
processes more than 250 million eligibility and prior authorization transactions, 470 million claims and payments in excess of $52 billion annually for New York Medicaid providers. The system supports statewide eligibility verification, claims processing and the New York Medicaid website. Additionally, the call center handles and receives nearly a million telephone calls a year from Medicaid providers, and the claims processing unit performs digital imaging and data conversion of paper documents. The critical systems, including eligibility verification, service authorization and pharmacy claims processing, are provided on a 24x7 basis. More than five million recipients receive health services through this program, with more than 75,000 participating healthcare providers providing their services, and over 8,400 system users.
Please provide a full listing of the day to day tasks to be performed by the Consultant (be descriptive and specific):
Reporting to the MMIS Service Operations Team Lead this position will assist in the operation of the Claims and Financial Subsystems of the NYS MMIS, eMedNY.
Duties include acting as ongoing liaison with the contractor, other state agencies, local districts, providers and federal representatives, and providing organizational coordination and assistance as required to facilitate the implementation of Medicaid initiatives.
The Claims Unit manages the information and decision support systems needed to make appropriate Medicaid payments for covered services, maintain reference files, and create financial reports as required by law and DOH policy as it relates to the NYS Medicaid system.
Specific responsibilities and duties will include:
• work collaboratively to identify and resolve Claims and Financial Subsystem problems and issues to assure that ongoing eMedNY operations are performing efficiently;
• provide SME support as needed for eMedNY Claims and Financial evolution initiatives;
• analyze and evaluate Claims and Financial Subsystem processes and interfaces including identification of impacts and appropriate remediation enhancements;
• report and provide support to eMedNY management on claims and financial issues; and, as directed, collaborate in and support the design, development and implementation of activities necessary to maintain DOH support functions with other state agencies, other federal agencies and the provider community;
• work collaboratively to interpret Medicaid policy vis-à-vis systems functionality, and participate in the development of DOH Medicaid initiatives;
• represent the DOH and eMedNY at seminars and training sessions as needed.
Which Service Group is required?
Service Group 1
What is the number of staff being requested?
(maximum of 5)
Which Job Title Category is required?
Which Skill Level is required?
Which Skill Demand is required?
How many Candidate Response Forms are being requested per Contractor per position? (1 or 2)
When is the Target Start Date?
(30 Business Days minimum from date of request)
How long is the engagement? (in months)
When is the estimated completion date?
Is this a Full or Part-Time Position (Full time is considered 40 Hours Per Week)?
If Part-Time, enter approximate number of hours per week:
What are the daily work hours? (note if negotiable or list preferred start and end time):
Where is the Home Base Region?
Where is the work office located? Enter Building Name (if known) Full Street Address, City, and ZIP
431A Broadway, Menands, 12204
What type of software is typically used by the Agency? (e.g., Agency is an "IBM shop.”)
What type of hardware is typically used by the Agency? (e.g., Agency is a "Client shop.”)
Position Mandatory Qualifications
- Manages small to medium-scale business analysis work or projects with distinct deliverables to a solution
60 - 84 Months
Candidate is able to work without assistance and can provide leadership for others; may have advanced education
Bachelor's degree in a Technical field.
ITIL (Information Technology Infrastructure Library) Certification.
At least 60 months of experience with the Title XIX New York State Medicaid Program.
At least 60 months of experience with large-scale claims payment systems such as eMedNY, with special emphasis on interfaces with other systems, including X12 transactions.
At least 48 months of experience in a Medicaid environment with the interactions between Medicaid, Medicaid Managed Care, Medicare, providers and other state and federal agencies and programs.
At least 48 months of experience doing Systems Analysis, Troubleshooting, or User support of Medicaid Claims Processing.
At least 48 months of experience doing Systems Analysis, Troubleshooting, or User support of Medicaid Finance.
At least 48 months of experience with developing and maintaining working relationships with local districts, the Medicaid provider community, other bureaus within the Office of Health Insurance Programs of the New York State Department of Health, other departments or federal agencies.
At least 48 months of experience working directly with PHI and PII daily in a HIPAA covered environment.
Additional Information Requests:
Are there additional security requirements for the Authorized User?
Signing of confidentiality agreements, such as a data exchange application agreement may be required if course of engagement requires handling of PHI or PII.
Will additional training possibly be required during the Engagement?
If Yes, provide description of anticipated training.
Contractors are required to attend mandatory workplace training. Examples of currently included courses are: HIPAA, Preventing Sexual Harassment, Preventing Workplace Violence, etc. In addition, training in eMedNY SDLC and new MMIS training will be required.
What type, or manner, of Knowledge Transfer is requested during the engagement?
Written knowledge transfer may be required as needed throughout the employment.
Is travel anticipated during the Engagement?
If Yes, please list anticipated frequency and locations for travel:
Limited travel as needed to coordinate and facilitate meetings between staff located in Albany, Menands, and Rensselaer.
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