Contract Insurance Eligibility Verification Jobs

APPLICANTS MUST BE PERMANENT IN THE PRINCIPAL ADMINISTRATIVE ASSOCIATE CIVIL SERVICE TITLE
The Department of Social Services (DSS) is comprised of the administrative units of the New York City Human Resources Administration (HRA) and the Department of Homeless Services (DHS). HRA is dedicated to fighting poverty and income inequality by providing New Yorkers in need with essential benefits such as Food Assistance and Emergency Rental Assistance. DHS is committed to preventing and addressing homelessness in New York City by employing a variety of innovative strategies to help families and individuals successfully exit shelter and return to self-sufficiency as quickly as possible.
The Bureau of Case Integrity & Eligibility Verification's mission is to maximize revenue generation for DSS/HRA/DHS and outside Agencies, ensure payments are categorically eligible for their respective funding streams and carry out cost avoidance projects to minimize audit disallowances.
The Office of Revenue Management and Development (ORMD) is requesting one (1) Principal Administrative Associate II to function as an Eligibility Verification Specialist in its Bureau of Case Integrity and Eligibility Verification (BCIEV)/ Case Integrity Unit, who will:
- Review and analyze Cash Assistance case records and computer data to determine which cases qualify for a category that is eligible for State and Federal funding. Identify retroactive obligations that have not been claimed and determine the effective date of adjustment for Federal and State reimbursements as established by case record entries and date of change and occurrence.
- Review invoices for families residing in domestic violence shelters with payments previously claimed as Safety Net (SN) or Title XX to determine which payments are eligible to be shifted to either the Emergency Assistance to Needy Families (EAF) or Family Assistance (FA). Determine the billing period: case category, individuals residing in the shelter, individuals case status, relationship between payee and child(ren), citizenship, number of eligible days per individuals. Also, ensures the EAF claim adjustment does not exceed the 135-day time limit for each individual. Adhere to tight claim deadlines.
- Review of rosters for families receiving Domestic Violence non-residential services to determine if the family meets the criteria to shift Title XX payments to Emergency Assistance to Needy Families (EAF). Confirming receipt of W145TT and participants attestation forms; tracking each individual's EAF eligibility to ensure EAF claim adjustments do not exceed the EAF eligibility period. Adhere to tight claim deadlines.
- Review Office of Temporary Disability Administration Invalid Social Security Number Validation files of Cash Assistance and Supplemental Nutrition Assistance Program (SNAP) individuals with an invalid Social Security Numbers to assist with minimizing audit disallowances and minimizing fraud. Verify clients' demographics and prepare Turnaround Documents (TADS), when applicable, to correct client demographics. Prepare reports of referrals to Investigation, Revenue and Enforcement Administration (IREA) for client call-in and suspected fraud cases.
- Keep abreast of current Federal, State and Agency policy and procedures to ensure categorical eligible payments adhere to all appropriate regulatory requirements. Assess the potential impact on claims and claim adjustments the requirements governing the various funding streams to ensure BCIEV is current and in compliance with existing funding requirements.
- Perform quality assurance for Enterprise Data Warehouse (EDW) queries testing and providing feedback to enhance EDW queries.
- Complete manual case lookups in response to press inquiries, FOIL requests, and DSS/DHS/HRA Senior staff requests, when data match results are inconclusive, to provide accurate details, case category and eligibility.
- Perform case review analysis of Agency audit findings of cases potentially claimed in an incorrect category.
- Work on numerous special projects involving other areas of the agency
- Provide back-up documentation to substantiate claims and claim adjustments submitted by Finance Office/ORMD units
- Create case records utilizing screenshots from Welfare Management System (WMS), HRA One Viewer, Systematic Alien Verification for Entitlements (SAVE), Paperless Office System (POS) and other systems
Hours/Schedule: 9:00 am to 5:00 pm
PRINCIPAL ADMINISTRATIVE ASSOC - 10124

1. A baccalaureate degree from an accredited college and three years of satisfactory full-time progressively responsible clerical/administrative experience, one year of which must have been in an administrative capacity or supervising staff performing clerical/administrative work of more than moderate difficulty; or
2. An associate degree or 60 semester credits from an accredited college and four years of satisfactory full-time progressively responsible clerical/administrative experience including one year of the administrative supervisory experience described in "1" above; or
3. A four-year high school diploma or its educational equivalent approved by a State's department of education or a recognized accrediting organization and five years of satisfactory full-time progressively responsible clerical/administrative experience including one year of the administrative supervisory experience as described in "1" above;
4. Education and/or experience equivalent to "1", "2", or "3" above. However, all candidates must possess the one year of administrative or supervisory experience as described in "1" above. Education above the high school level may be substituted for the general clerical/administrative experience (but not for the one year of administrative or supervisory experience described in "1" above) at a rate of 30 semester credits from an accredited college for 6 months of experience up to a maximum of 3 years.

The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.