Department: Health Systems Transformation
Location: Albany, NY
NYSTEC is a nonprofit technology consulting company, advising agencies, organizations, institutions, and businesses since 1996. We’re independent and vendor-neutral, so we have our clients’ best interests at heart. At NYSTEC, we know that we succeed when individuals and teams flourish personally and professionally, so our benefits and perks support that mindset. Are you ready to contribute to our engaged workforce and deliver the NYSTEC Experience?
About the Role:
The New York State Medicaid Health Home Program was designed to help eligible New Yorkers experiencing barriers to care get the care and services they need to stay healthy. A health home is a group of healthcare and service providers responsible for integrating and coordinating all primary, acute, behavioral health, and long-term services and supports for eligible members. After the initial three-year designation period, the New York State Department of Health and its state partners conduct collaborative reviews of quality and performance measures to determine if health homes across the state qualify for redesignation.
As a clinical care analyst, you will collaborate with team members to conceptualize, deliver, and support our clients through today’s ever-changing landscape. Your day-to-day role as a consultant will be providing clinical care analysis expertise to evaluate the qualifications of health homes across the state for designation/redesignation status.
- Evaluate Health Home Redesignation case for compliance to applicable regulations.
- Clearly communicate evaluation requirements and follow up.
- Evaluate documentation against applicable regulations.
- Collect data and documentation to support compliance findings.
- Use technology to convert hard copy documentation to an electronic format and submit via secure file transfer.
- Record and summarize compliance findings for the Health Home Program.
- Assist in determining trends in noncompliance.
- Make appropriate and timely recommendations to project management.
- Assist with the ongoing operationalization of project processes and procedures.
- Build and maintain relationships with stakeholders to provide a high level of customer service.
- Coordinate as needed to schedule onsite visits.
- May require travel to complete on-site reviews on an ongoing basis by region within the New York state.
- A minimum of four years of experience as a registered nurse (RN), licensed mental health counselor (LMHC), licensed clinical social worker (LCSW), care manager, or healthcare compliance analyst in a role working with critical care providers, public health providers, or providers that care for children, older adults, persons with traumatic brain injury, persons with emotional disturbances, or persons with developmental disabilities.
- One year of experience with monitoring compliance or fee-for-service Medicaid or managed care billing.
- Experience with compliance audits or chart reviews.
- Exceptional customer service relationship techniques, including superior verbal and written communication skills.
- Excellent attention to detail in completing assigned tasks.
- Proficiency in MS Excel, MS Word, MS Outlook, MS Visio, MS PowerPoint, and MS SharePoint.
- For this role, travel is required approximately 10% of the time. Work can be completed remotely as needed.
- Working knowledge of Health Homes Redesignation program, including a good understanding of the redesignation process and requirements. Experience working with eMedNY, CANS-NY, UAS-NY, Medicaid health homes, Medicaid managed care organizations (MCOs), or other related systems/programs/organizations.
- Knowledge of NYS Medicaid billing practices/systems.
- Experience with electronic health record (EHR) systems.
- Experience working with the New York State Office of Mental Health (OMH), New York State Office for People with Developmental Disabilities (OPWDD), or New York State Office of Children and Family Services (OCFS).
- Ability to work with and relate to staff and demonstrate active listening skills.
- Process-oriented and results-driven work strategy.
- Ability to foster teamwork with all levels of management and staff.
- Ability to work well independently and within a team.
- Experience in meeting deadlines and adhering to strict standards.
Education and Experience
- A bachelor’s degree in healthcare or public health study and two years of related experience, or an equivalent combination of advanced education, training, and experience.
If you’re an effective communicator who enjoys working in complex and collaborative environments, using your critical thinking and research skills to develop solutions for clients and providing support to customers, and you have the required education, experience, and skills, we want to hear from you.
Employees are required to comply with NYSTEC’s Vaccination Policy and Prevention Plan. Our policy requires proof of vaccination status or agreeing to submit weekly COVID-19 tests via our ADP portal. New York City office employees and travelers are required to submit proof of vaccination or apply for a workplace accommodation request in accordance with NYC Emergency Executive Order No. 98.
It is NYSTEC’s policy to provide equal employment opportunity (EEO) to all individuals, regardless of actual or perceived race, color, creed, religion, sex or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), age, national origin, ancestry, citizenship status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, military service and veteran status, sexual orientation, marital status, or any other characteristic protected by local, state, or federal laws and ordinances. NYSTEC is strongly committed to this policy and believes in the concept and spirit of the law.
Applicants must be authorized to work in the United States without the need for visa sponsorship now or in the future.
Learn more about NYSTEC by visiting www.nystec.com.