Occ. Code 6884300
DISABILITY ANALYST 3, GRADE 23
DISABILITY ANALYST 4, GRADE 25
DISABILITY ANALYST 5, GRADE 27
DISABILITY DETERMINATIONS PROGRAM MANAGER, M-4
New York State Department of Civil Service
Positions in this series supervise the review and administrative adjudication of claims for benefits under Title II and Title XVI of the Social Security Act (SSA). They provide expertise on SSA rules and regulations on case processing, including face-to-face adjudications to terminate benefits; assess the quality of claims processing and determinations for efficiency; coordinate training; evaluate regional programs; and oversee the Automated Case Processing System.
Positions in this series exist only in the Office of Temporary and Disability Assistance, Division of Disability Determinations (DDD).
DISABILITY ANALYST 3: supervisory level; oversees review and determination of cases, including the more complex hearing and pre-hearing preparation cases, aged or delayed cases, and claims with high level congressional or public official inquiries.
DISABILITY ANALYST 4: supervises a module consisting of multiple processing units within a region, or a unit primarily responsible for medical review of claims.
DISABILITY ANALYST 5: supervises several processing modules within a regional processing center and plans, directs and coordinates development and dissemination of new and updated legislation and policy regarding disability programs.
DISABILITY DETERMINATIONS PROGRAM MANAGER: administers federal and State policies related to disability insurance claims; interprets procedures and policies related to the adjudicative process of claims; and oversees the operation of a processing center.
DISABILITY ANALYST 3
When assigned to a case processing unit, supervises a unit of Disability Analysts 2 in developing and determining claims for benefits and may do any of the following:
· Ensures that cases are processed efficiently and accurately by periodically reviewing a sample of cases at different stages of development for completeness, timeliness and appropriateness of any action or determination.
· Assists staff by suggesting methods for case analysis; reviews cases and sources to be contacted for proper case development; provides information on precedent cases; refers staff to specific policies and procedures to be followed; and provides alternatives to usual methods of case development.
· Corrects procedural, substantive and judgmental deficiencies noted in the case review and instructs staff in the specific technique, policy and procedure to be followed to ensure proper case development and determinations.
· Reviews statistical production reports to identify problems in meeting acceptable production targets and sets goals, defines and solves work problems and trains staff on new policies.
· Consults with medical personnel or the Quality Assurance Unit to support initial case development or determination; reviews additional case development for completeness and soundness of judgment before referring the case back to the medical consultant or the Quality Assurance Unit.
· Adjudicates difficult aged or delayed cases and reviews pre-hearing cases prior to forwarding them to the Hearing Unit.
· Ensures each case is complete and that the decision to stop benefits is correct. If decision to stop benefits is incorrect, ensures benefits are resumed and cancels hearing.
· Reviews claims and cases returned by Quality Assurance Unit, medical consultants or federal examiners for inadequate case development or disagreements on the case determination and returns or refers the case back to Quality Assurance or the medical consultant.
When assigned to Quality Assurance, reviews a sample of cases developed and determined by examining staff to ensure compliance with policies and procedures and to maintain high quality and timely determinations.
· Reviews sample cases and those returned by federal examiners and evaluates the adequacy of the case preparation and determination based on conformity to policy and procedure, proper application of case determining factors and adequate documentation in support of the determination.
· Returns federally reviewed cases, summarizing the nature of the problem identified and if necessary requests explanation of the policy basis of the federal findings.
· Reviews all cases returned by the federal reviewer and, following the reexamination of the claim, returns the case to the federal reviewer.
· Returns cases containing errors to the appropriate case processing unit supervisor for action or corrects the errors and prepares reports for corrective action.
· Reviews the case when returned from the supervisor in the case processing unit for comment and/or action and follows up until the case is complete.
· Evaluates staff performance in accordance with office policy regarding quality and timeliness standards or to evaluate the effectiveness of training.
· Prepares periodic reports on work performance, case processing, problems or other issues.
· Reviews a sample of imaged cases to ensure appropriateness, accuracy and quality.
· Enters all quality assessment reviews in the Quality Assurance Database.
· Acts as a vocational consultant; reviews and advises on complex vocational issues in accordance with SSA rules and regulations.
When assigned to the Hearings Unit, reviews determinations for correctness and determines eligibility or ineligibility for benefits and conducts face-to-face hearings to cease benefits.
· Reviews the case and takes any required action for an administrative hearing as requested by the claimant.
· Prepares a Summary of Evidence, listing the sources of evidence used in making the last continuing disability review decision and notes any issues requiring clarification at the time of the hearing.
· Determines eligibility for benefits that may override an earlier determination of cessation.
· If the evidence in file does not permit a fully favorable decision, schedules and conducts a face-to-face hearing following SSA procedures or, with supervisory approval, returns the case for additional development to the Disability Analyst 2 responsible for the case at the pre-hearing level.
· Prepares a report of the hearing, identifies medical and vocational issues, notes observations at the time of the hearing, and renders a decision.
Automated Case Processing (ACP)
When assigned as an Automated Case Processing (ACP) Coordinator, provides support for all ACP and program related systems applications.
· Coordinates with the Divisions system unit to ensure that all files, records and applications on the Divisions legacy system are properly maintained, that the functions of NDDS, the legacy system on the federal systems side, are working properly and that any problems or delays in either system is promptly identified and reported to the Divisions system unit.
· Trains staff working with the Divisions system and the federal system on inquiries, folder requests, case reporting, and case inventory, and acts as a backup security officer on the federal system.
· Reports all ACP application anomalies, assesses whether they are procedural, system or user errors and refers problems to the Divisions system unit for corrective action.
· Serves as a member of the Divisions Statewide User Committee to present and explain regionally endorsed suggestions for modification and enhancements to the ACP.
When assigned as a training coordinator, provides regional support for the planning and coordination of Division-wide training activities and report preparation, and may assist in quality reviews and program evaluation trends to plan and develop training for the Division.
· Develops and delivers training to staff on medical, policy and procedural issues and computer programs related to disability claims process; may write curricula, manuals or handouts to assist in the training process.
· Identifies, prioritizes and plans training activities.
· Mentors staff by providing guidance and training in such areas as case development, documentation requirements, caseload management and desk organization.
· Keeps staff informed of available training opportunities and resources; acts as liaison between staff and various external training organizations such as OTDA, SSA, etc., and arranges for access to training.
· Supervises data entry for training database; and prepares reports on training activities.
DISABILTY ANALYST 4
Supervises a group of units responsible for case processing, quality assurance, training or medical review.
When assigned to case processing, quality assurance or ACP oversight:
· Ensures that the quantity and quality of determinations meet established goals and standards; examines production statistics and ensures remedial actions are taken to maintain goals.
· Directs and trains first-line supervisors and directs the assignment and reassignment of work.
· Coordinates activities of the unit to maintain timely and accurate determinations; meets with other supervisory staff to coordinate workload and processing activities.
When assigned to a medical records liaison function:
· Ensures that medical evidence on record from treating sources and Consultative Examination (CE) providers is received timely and is high quality; ensures that medical resources are available to Division analysts.
· Meets with, informs and educates the medical, educational and advocacy communities and other organizations, agencies, schools, and institutions about the disability program requirements.
· Ensures that the CE panel of experts is adequate; recruits, enrolls, trains, selects and maintains the panel according to policy; takes corrective actions in line with reported quality reviews, claimant interviews, and complaint investigations.
· Develops and implements specialized programs with health care providers and other institutions to meet particular needs of the regional offices.
· Negotiates with and monitors field facilities, hospitals, clinics and schools that provide medical records needed to adjudicate claims.
DISABILITY ANALYST 5
Supervises a group of modules responsible for case processing, quality assurance, training or medical review; supervises operations and production of analyses; and develops new policies arising from new and changed laws, rules and regulations.
When assigned to oversee program integrity and quality assurance:
· Reviews proposed changes in federal and State law and regulations to assess operational impact on DDD and prepare written analyses.
· Analyzes quality performance trends in Statewide operations; identifies corrective actions or remedial staff development actions to ensure compliance with federal quality performance standards.
· Develops strategies to use emerging technologies in cooperation with other Division staff; plans and directs activities to further the efficiency and effectiveness of Division operations.
When assigned to a Statewide Division training function:
· Plans, develops, reviews and evaluates training programs to ensure the availability and high quality training for staff.
· Recommends curriculums and training schedules and responds to identified deficiencies during case processing to quickly address gaps in specific training.
· Develops and maintains an information library within the Division; acts as liaison with federal offices regarding training programs.
· Oversees the development and maintenance of a training database to document available training.
DISABILITY DETERMINATIONS PROGRAM MANAGER
Develops and administers policies related to Disability Insurance claims.
· Interprets procedures and policies related to claims processing and coordinates the uniform application of these policies and procedures.
· Serves as liaison with the federal regional office to discuss potential and existing problems in proposed, new or existing standards and regulations for adjudication of disability claims.
· Analyzes existing and proposed legislation impacting center operations and recommends changes.
Ensures the smooth operation of a processing center by acquiring needed resources, monitoring case processing and making necessary adjustments.
· Directs the preparation of all required State and federal expenditure reports; and provides justification for federal budget submissions.
· Establishes operational goals and objectives; and develops and implements a plan for meeting these goals and objectives.
· Identifies existing or potential problems in implementing plans and recommends changes based on the peculiarities of the States method of adjudicating claims.
· Analyzes center operations to determine needs for supporting medical staff; arranges for the assignment of such staff (both in numbers and types of specialties) to ensure that medical determinations are consistently and efficiently processed.
· Ensures that adequate office support and administrative services are provided to meet production and performance standards set by the State and federal government.
· Identifies, in consultation with managers, training needs to correct and improve practices within the assigned center; and arranges for the delivery of such training.
· Identifies security improvements and consults with the security office in implementing steps to ensure the safety of staff.
· Participates with other Division staff in developing program studies and evaluations to locate weaknesses in operational or administrative procedures or to develop new methods and processes.
Maintains liaison with federal, State, county and civil agencies whose clientele is seeking or receiving SSA disability benefits.
DISABILITY ANALYST 3
One year of permanent service as a Disability Analyst 2.
DISABILITY ANALYST 4
One year of permanent service as a Disability Analyst 3.
DISABILITY ANALYST 5
One year of permanent service as a Disability Analyst 4.
DISABILITY DETERMINATIONS PROGRAM MANAGER
One year of permanent service as a Disability Determinations Regional Administrator, or two years of permanent service as a Disability Analyst 5.
NOTE: Classification Standards illustrate the nature, extent and scope of duties and responsibilities of the classes they describe. Standards cannot and do not include all of the work that might be appropriately performed by a class. The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written. Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.