Senior Health Care Management Systems Analyst (NY HELPS)

Job Description

The Senior Health Care Management Systems Analyst (SHCMSA) G-18, in the Office of Health Insurance Program's Division of Health Plan Contracting and Oversight, will serve within the Bureau of Managed Care Fiscal Oversight in the Financial Report and Oversight Unit, and will play a vital role in the review of Cost Reports and Medical Loss Ratio (MLR) Reports to ensure compliance/accuracy of Managed Care Organizations (MCO's) mandated program regulations and compliance standards.
The Associated Duties for this position are as follows:
1. Collaborate with other BMCFO and Plan staff to develop program analysis, evaluate the effectiveness of the alternatives, and assess data output to ensure it supports the needs of the agency.
2. Responsible for reviewing the quarterly financial reports for Medicaid Managed Care plans and Managed Long Term Care Plans. Make changes to the software to account for new benefits, programmatic changes, new premium groups, etc. BMCFO makes changes and test software as well as assist plans with reporting questions.
3. Develop and maintain MLR SFY Annual Reporting for Managed Care lines of business (Medicaid, HARP, HIV SNP, MLTC Partial, MAP and PACE) by premium group, quarter, and region. Also develop and maintain the EP MLR and CHP MLR CY Annual Reporting.
4. Development and maintenance of review tools to review plan Solvency including tools for the calculation of the Contingent Reverse Requirement, Escrow Requirement, Premium Income and Net Income Profit & Loss, and MLR Liability for plan solvency and a multi-year trend analysis of different categories.
5. Maintain and develop Excel spreadsheet to prepare statistical reports to develop policy and procedure briefs, letters, memoranda and other written materials on specific Financial Reporting issues.

Minimum Qualifications:
Permanent Transfer Candidates: Current New York State Department of Health employee with permanent or contingent-permanent, competitive, status, as a Senior Health Care Management Systems Analyst, SG-18 OR; a current New York State employee with one year of permanent or contingent-permanent, competitive, service in a title eligible for transfer under Section 52.6, 70.1 or 70.4 of the NYS Civil Service Law to Senior Health Care Management Systems Analyst, SG-18, Health Care Management Systems Analyst, Trainee 1, NS, or Health Care Management Systems Analyst, Trainee 2, NS.
Non-Competitive Candidates via NY HELPS Program:
Senior Health Care Management Systems Analyst: A bachelor's or higher degree and two years of professional experience in conducting public policy research and analysis in finance.
Health Care Management Systems Analyst, Trainee 2: A bachelor's degree AND one year of professional experience in conducting public policy research and analysis in finance.
Health Care Management Systems Analyst, Trainee 1: A bachelor's or higher degree.
*Substitution: a Juris Doctor, master's or higher degree in a related field can substitute for one year of specialized experience.
Preferred Qualifications: Critical thinking skills and analytical skills, ability to solve problems independently. Professional work experience and/or education in healthcare and trend analyses.

Requirements

Permanent Transfer Candidates: Current New York State Department of Health employee with permanent or contingent-permanent, competitive, status, as a Senior Health Care Management Systems Analyst, SG-18 OR; a current New York State employee with one year of permanent or contingent-permanent, competitive, service in a title eligible for transfer under Section 52.6, 70.1 or 70.4 of the NYS Civil Service Law to Senior Health Care Management Systems Analyst, SG-18, Health Care Management Systems Analyst, Trainee 1, NS, or Health Care Management Systems Analyst, Trainee 2, NS.
Non-Competitive Candidates via NY HELPS Program:
Senior Health Care Management Systems Analyst: A bachelor's or higher degree and two years of professional experience in conducting public policy research and analysis in finance.
Health Care Management Systems Analyst, Trainee 2: A bachelor's degree AND one year of professional experience in conducting public policy research and analysis in finance.
Health Care Management Systems Analyst, Trainee 1: A bachelor's or higher degree.
*Substitution: a Juris Doctor, master's or higher degree in a related field can substitute for one year of specialized experience.
Preferred Qualifications: Critical thinking skills and analytical skills, ability to solve problems independently. Professional work experience and/or education in healthcare and trend analyses.