Healthcare Program Specialist � Item 1064- DHPCO
Additional Requirements and Day-to-Day Tasks of Position
This individual will act as a Complaint Investigator (Complaint Investigation Unit) in the Department of Health�s Office of Health Insurance Programs (OHIP)/Division of Health Plan Contracting and Oversight (DHPCO) /Bureau of Consumer Services (BCS) and will carry out all complaint investigation activities including:
- Following Division policies and procedures, conducting investigations between the various partners, plans and associated state agencies to appropriately resolve enrollee or provider complaints in a timely manner and/or respond to inquiries and requests for information.
- Corresponding in writing, telephone, and/or email with complainants including providers, plans and consumer regarding the status and outcome of their complaint investigation.
- Routine reporting on complaint investigation statistics including volume, case load per investigator, plan allegations, etc.
- Other activities as may be deemed necessary in response to the changing needs of the Division
- Coordinating Executive Correspondence (ECU�s) for the Bureau
- Maintaining organized case files with current case information always
- Superior communication skills.
- Strong organization skills and ability to multitask;
- Ability to independently, creatively and strategically complete projects;
- Ability to meet competing deadlines;
- Proficiency in the use of standard office technology and Microsoft Office applications, including Word, Excel, Access, and PowerPoint
- Knowledge of eMedNY a plus
EDUCATION AND EXPERIENCE REQUIREMENTS:
- Bachelor�s degree in business management, nursing, health care administration, or related field;
- Two (2) years of demonstrated progressive work history in healthcare fields with concentration in utilization review, medical/clinical billing, customer service/helpline, complaint investigations,
- New York State public health medical assistance insurance or managed care or healthcare policy and administration.
Position and Minimum Qualifications:
Health Program Specialist
2 Years� experience