New York State of Opportunity

New York State Department of Civil Service Announces Open-Competitive Examination Open to the Public

Medicaid Eligibility Examiner 4

Evaluation of Training and Experience To Be Held During
April 2015
Applications Must Be Submitted or Postmarked By
March 04, 2015


Exams Included on This Announcement
Exam Number Exam Title Salary Salary Grade Non−Refundable Processing Fee
80-196 Medicaid Eligibility Examiner 4 $61,022 G-21 $0

Appointees who work in the five boroughs of New York City or in Nassau, Suffolk, Rockland, or Westchester Counties will receive an additional $3,026 annual downstate adjustment. Appointees who work in Dutchess, Orange, or Putnam Counties will receive an additional $1,513 annual mid-Hudson adjustment.

Back To Top

Minimum Qualifications

On or before April 30, 2015, you must have six years of full time experience, two years of which must have included supervision of staff, performing at least one of the six activities listed below in any of the following programs that: provides reimbursements for health care services; works with social services program areas; determines eligibility for a consumer assisted program in a hospital or other health care facility; provides health care regulatory oversight; or performs quality assurance and interpretation/application of standards of health care.


Either 1. determining eligibility for a health care or consumer assisted program in which financial eligibility criteria must be met;

Or 2. performing utilization review, including pre-payment or post-payment review of requested health care services, prior approval or authorization activities, adjudication or pricing of claims for payment; or analysis of patterns of health care;

Or 3. determining reimbursement and financing of health care services, including rate-setting or approval, establishing capitation reimbursement methodologies, assessing fee schedules, coding constructs for medical goods and services, or applying/processing of reimbursement methodologies;

Or 4. performing quality assurance activities such as ensuring compliance with laws, rules, regulations, and policies;

Or 5. inspecting, assessing, or monitoring health care programs or facilities for certification, licensure or adherence to laws, rules, regulations, and policies;

Or 6. planning, designing, developing, researching, or evaluating proposals to establish or refine programs, with ongoing responsibility for interpreting legislation or regulations, defining/describing target populations and local demographics, grant/proposal writing, or developing, reviewing, and evaluating contracts.

Substitution: College credit may be substituted for up to three years of the general experience at the rate of 30 college credit hours equaling one year of experience. You must clearly demonstrate how you meet the remaining years of experience; two years of which must include supervision of staff.

For the purposes of this exam, qualifying experience settings may include, but are not limited to: local district social services, hospitals or other healthcare facilities, health insurance companies, and health insurance call centers.

Non-qualifying experience includes patient advocates, case managers, direct care experience, clerical and data entry duties, billing clerk, receptionist or scheduler in a physician���s office or hospital.


  1. There is no processing fee for this exam.
  2. Application must be mailed directly to the New York State Department of Health; see ���Where to Apply.���
  3. Your degree or college credit must have been awarded by a regionally accredited college or university or one recognized by the NYS Education Department as following acceptable educational practices. If your degree or college credit was awarded by an educational institution outside the United States and its territories, you must provide independent verification of equivalency. You can write to the Examination Information Desk of the NYS Department of Civil Service for a list of acceptable companies who provide this service. You must pay the required evaluation fee.
  4. If you meet the Minimum Qualifications you may also be interested in competing in Examination No. 80-194 Medicaid Eligibility Examiner 2 and Examination No. 80-195 Medicaid Eligibility Examiner 3.
  5. Appropriate part-time and volunteer experience, which can be verified, will be accepted on a prorated basis.
  6. New York State residence is not required.

Back To Top


As a Medicaid Eligibility Examiner 4, you would serve as a manager and administer and direct multiple public health insurance eligibility enrollment functions or a large program; ensure adherence to laws, rules, and regulations as well as analyze and interpret state and federal legislation, make recommendations regarding eligibility laws, rules and regulations, and interpret and communicate state and federal laws and codes to implement policies and procedures, ensure efficient program implementation and consistent and correct application of eligibility guidelines; review the most difficult or problematic applications or renewals; communicate program changes to subordinates and ensure changes are incorporated accurately, and plan and conduct or arrange for training of staff.

Back To Top

Subject of Examination

There will be no written test. The test will consist of an evaluation of your education and experience. When you apply, you must provide complete information to show that you meet the minimum qualifications. Do NOT send resumes. If you apply using the NYS-APP form and you need more space, attach additional 8��" x 11" sheets following the same format used on the application form. Additional unsolicited information will not be accepted after the last date for filing.

If you meet the Minimum Qualifications you will be sent a supplemental questionnaire to complete and return to the New York State Department of Health. The questionnaire will be used to evaluate the level, length, and relevance of your education and experience against the general background/critical activities of the position. This questionnaire will be the only basis for rating your education and experience.

Your final score must be 70 or higher in order to pass. Rank on the eligible list will be determined after adding any wartime veterans' and Civil Service Law Section 85-a credits to your final passing score.

How to Apply

Where to Apply

Mail your completed application to:

Additional Information

New York State is an Equal Opportunity Employer

It is the policy of the State of New York to provide for and promote equal opportunity employment, compensation, and other terms and conditions of employment without discrimination on the basis of age, race, color, religion, disability, national origin, gender, sexual orientation, veteran or military service member status, marital status, domestic violence victim status, genetic predisposition or carrier status, or arrest and/or criminal conviction record unless based upon a bona fide occupational qualification or other exception.

Appointment to many positions in State government require candidates to undergo an investigative screening. This may include a thorough character investigation, a Federal Bureau of Investigation Criminal Record History Check, a Child Abuse Registry clearance, or other similar procedures. Candidates may be fingerprinted and may be required to pay any necessary fees for that procedure. Depending on the nature of the job, the criminal convictions discovered, or any falsified or omitted information revealed, the investigative findings may bar appointment or result in removal after appointment.

Eligibility for Employment

You must be legally eligible to work in the United States at the time of appointment and throughout your employment with New York State. If appointed, you must produce documents that establish your identity and eligibility to work in the United States, as required by the federal Immigration Reform and Control Act of 1986, and the Immigration and Nationality Act.

Issued: 1/30/2015

This announcement is subject to amendment or cancellation without notice. Do not copy it, or post it to any other site, but link to it instead.

Back To Top