Health Program Administrator

Overview

Duties Description Within the Division of Health Plan Contracting and Oversight, in the Bureau of Managed Fiscal Oversight, the incumbent will have both administrative and managerial responsibilities associated with oversight of the MCO encounter data and all relevant duties. Specific responsibilities may include but are not limited to:

• Supervision, oversight and training of the professional staff assigned to the Unit.
• Serving in a liaison role, providing technical assistance to MCOs and Department staff on encounters compliance and oversight with State and federal policy, rules and regulations.
• Collaborate with program, rate setting and State’s actuary staff to develop and recommend objectives for encounter oversight and analysis in relation to data submitted by the MCO to assure data timeliness, completeness and accuracy as well as assess data output quality to ensure it supports the analytic needs of the agency.
• Responsible for the analysis and interpretation of monthly validation and compliance reports used to determine adherence to data accuracy, review data completeness and timely submission and monitors the enforcement and adherence to the submission and reporting guidelines.
• Provide oversight of staff research, analysis and evaluation of encounter data submitted by Managed Care Organizations.
• Review validation and compliance report findings identified by staff and prepare comprehensive reports of analysis for distribution and outreach to MCOs. Address ad hoc data requests including data pulls for policy/program development and audit/oversight agency responses.
• Collaborate with members of the cost report and rate setting teams to ensure data correlation and accuracy meet State established standards.
• Lead and monitor processes performed by staff necessary to evaluate timeliness and accuracy of MCO financial reports submitted by the MCOs to verify financial condition, analyze fiscal operations and compliance with fiscal reporting requirements, reserve and escrow fund requirements pursuant to related laws, regulations and internal Bureau policies.
• Maintain and develop SAS and SQL coding to extract data from MDW and OHIP Data-mart as necessary to prepare statistical reports to develop policy and procedure briefs, letters, memoranda and other written materials on specific encounter data issues. Use SAS Viya and other analytical tools to present data analysis in a dynamic interactive manner.

• Current NYS DOH employee with a permanent or contingent-permanent, competitive status as a Health Program Administrator 2, G25 OR a NYS employee with one year or more of permanent or contingent-permanent, competitive service in a title at or above a G23 and deemed eligible for transfer to a Health Program Administrator 2, G25 under Section 70.1 or Section 52.6 of the NYS Civil Service Law.

• Critical thinking skills, analytical skills, SAS Viya, Microsoft Excel, with ability to manipulate large databases, and write and/or utilize SQL code to pull data as needed to solve problems.
• Professional work experience and/or education in healthcare and data and trend analyses.

The NYS Department of Health is committed to making New York a safer, healthier, and more equitable place to live. Understanding health equity, social determinants of health and health disparities is critical to accomplish our goal of eliminating health disparities. For more information on the NYS Department of Health’s Mission, Vision, Values and Strategic Plan, please visit health.ny.gov/commissioner/index.htm. If you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone  or email doh.sm.reasonable.accommodation.gov

to make a request. NYS Department of Health does not participate in E-Verify and does not sponsor visa applications. For new State employees appointed to graded positions, the annual salary is the hiring rate (beginning of the Salary Range) of the position. Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations and negotiated union contracts.

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