Healthcare Organizational Operations Administrator

Staffing Solutions Organization LLC (SSO), an affiliate of Public Consulting Group LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve.

Healthcare Organizational Operations Administrator, Albany, NY

DEMI – 1159

Summary

Review information submitted to the Bureau of Third Party Health Insurance, Medicare Savings Program and Recoveries from a variety of sources including, but not limited to, Medicaid Managed Care Organizations (MMC), other internal units/Bureaus.  Make the necessary determination regarding any necessary updates to eMedNY and possible MMC premium recovery.

Analyze and verify Third Party Health Insurance (TPHI) relative to client information and perform verifications and determinations as they apply to Medicaid Managed Care (MMC) enrollment.

Determine when action is necessary regarding recovery of capitation payments and direct the necessary information to the appropriate individual or unit to initiate the recovery process.

Take appropriate actions regarding Medicaid enrollment and premium reimbursement.

Create and modify Health Insurance Premium Payment/Medicaid Insurance Premium Payment Program (HIPP/MIPP) payees as necessary.

Gather information from employers and/or insurance carriers for determining cost-effectiveness of TPHI.

Calculate the cost-effectiveness of TPHI using the HIPP calculator in eMedNY.

Communicate via phone with MMC Plans, carriers, clients and coworkers. 

Handle incoming phone calls from Medicaid clients with questions Review eMedNY, New York State of Health (NYSoH) Back Office , Key Total Treasury (KTT), and JIRA to determine the status of checks and assist clients in resolving their questions.

Review and resolve JIRA issues related to returned premium reimbursement checks, stop payment and reissue requests, 90-day letters, and payments received.

Basic Qualifications

High School graduate or equivalent, 3 years administrative experience

Desired Characteristics

Preferred candidates will have professional experience in public health insurance programs, including New York’s Medicaid, Medicare and/or Child Health Plus. Preferred candidates will also have excellent verbal and written communications skills; strong analytical skills and attention to detail; strong organizational skills; proficiency in Microsoft Office (Word, Excel, Access); the ability to work well independently and as part of a team, and to manage multiple priorities in order to meet deadlines; and experience using electronic data systems, such as eMedNY and NYSOH Back Office.

Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides a reasonable range of compensation for this role. In addition, SSO provides a range of benefits for this role.

All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an e-Verify participant.