Occ. Code 8161610













New York State Department of Civil Service


Classification Standard





Positions in this title series are assigned duties related to the New York State Medicaid Program and other public health insurance programs within the Department of Health (DOH).  Incumbents provide technical assistance and guidance, as well as program knowledge and expertise, to local social service districts, other DOH program areas, other State agencies, clients, health care providers, professional organizations, insurance companies, as well as advocacy groups. 




MEDICAL ASSISTANCE SPECIALIST 1: entry level; incumbents perform a wide range of duties to assist in administration, supervision, monitoring, and evaluation of program areas relating to Medicaid, Family Health Plus and Child Health Plus.  Most incumbents likely will begin to build an expertise in a smaller, more specialized program area.


MEDICAL ASSISTANCE SPECIALIST 2: advanced performance level; assists in the development of policies; recommends modification to procedures, guidelines, and program reporting requirements as needed; and handles assignments where there are no clear precedents.


MEDICAL ASSISTANCE SPECIALIST 3: supervisory level; supervises a unit having responsibility for a significant Medicaid, Family Health Plus and Child Health Plus program or a portion of a larger program area. 


MEDICAL ASSISTANCE SPECIALIST 4: managerial level; serve as the head of a Bureau or other significant Medicaid, Family Health Plus and Child Health Plus  program area within DOH. 






Assist in the review, development, analysis and interpretation of legislation, rules and regulations, and policy statements relating to Medicaid and other public health insurance programs.


·         Receive and review requests for information relating to Medicaid, Family Health Plus and Child Health Plus programs.  Research issues and respond appropriately in writing or verbally.

·         Assist in drafting preliminary regulations and explanatory material such as health care provider letters and local district advisories for review.

·         Analyze differences between proposed and existing legislation to determine what program or policy changes will be necessary.

·         Assist in the implementation of policy and regulation changes.


Make field visits and otherwise provide technical assistance to local social services, other DOH program areas, and other State and local agencies to improve or correct agency operations.


·         Review activity reports from local agencies, program audit reports, recipient and health care provider complaints, and district annual plans to identify problems such as incorrect eligibility determinations, and make recommendations to improve or correct a local program.

·         Discuss administrative changes, recommendations, and suggestions with local administrators to improve operations, solve problems, better serve the public, and bring the program into compliance with State and federal guidelines.

·         Prepare formal communications to local Social Service Commissioners regarding program administration.

·         Recommend controls for compliance with required changes and prepares reports on progress.

·         Make follow-up visits to reassess problems affected by changes, and suggest further modifications, reset deadlines, and gather further information.

·         Provide program guidance to local district administrators and staff to assist them in resolving issues and problems as well as understanding and implementing program changes.

·         Identify problems in program design and make recommendations to State program administrators.


Review and update prepared material used to train local district and entities assisting with program enrollment, and provide information for and direction to health care provider staff and recipients of specialized Medicaid programs.


·         Collect resource data and other program-related information to ensure proposed training material is current.

·         Prepare suggested changes relating to areas in need of development, or changes needed, to reflect current policy and regulation.


Assist in the review of operations of specific programs, Medicaid health care providers, State agencies, local districts, demonstration projects and automated systems against established standards.


·         Collect data on the operation by site visits and review of reports.

·         Analyze the data collected to determine deficiencies.

·         Inform supervisor of deficiencies and recommend corrective action. 


Assist in development of policy papers, correspondence, press releases, Administrative Directives, Health Care Provider Instruction Manuals and other policy documents, utilizing program knowledge and expertise.  May be required to perform some research and analysis activities.


May be assigned to assist business systems and requirements analysis technical staff in the development and operation of automated systems.


·         Develop a description of intent of and operation of the system.

·         Define data needs in user terms for systems staff.

·         Evaluate the results of systems testing to determine if system is meeting program needs.

·         Propose changes to systems to ensure the needs of program are met.

·         Define data needs for reporting.

·         Draft material needed for users containing the information needed to implement and operate Medical Assistance programs.


Supervision and/or completion of daily activities of a production-orientated unit processing provider enrollment applications, prior approval requests, pended claims and/or fee and rate file development and maintenance.


Attend meetings with other DOH program areas, other State agencies, other program divisions and health care provider and/or advocacy groups to assist in the discussion of Medicaid programs, policy and systems issues.  Aid in the resolution of problem issues.




May perform any of the duties of a Medical Assistance Specialist 1.


Assist in the development of policy; recommend modification to procedures and reporting systems for implementing programs and programmatic changes.


·         Review, analyze, and interpret State and federal legislation, policy statements, and rules and regulations relating to medical assistance.

·         Develop procedures required to ensure all mandates of the program have been met.

·         Prepare legislative proposals and regulatory amendments, impact statements, and program analysis.

·         Draft policies by which local districts, other State agencies, and providers will operate programs to meet client needs.


Review the operations of Medicaid providers, State agencies, local districts, and automated systems against established standards.


·         Collect data on the operations in the assigned areas of responsibility by review of reports, phone contacts, and other methods, and analyze the data collected.

·         Inform health care providers, agency, system, or local district staff of deficiencies so corrective action can be taken.

·         Provide technical assistance where necessary.

·         Review and evaluate State and federal initiatives in the medical assistance area to determine the impact of these initiatives on existing programs and potential initiatives.

·         Assist State and federal audit staff in their activities.


Work with systems staff in the development of automated systems for management reporting, claims processing and case handling to collect data, process case reviews, pay providers, evaluate services, prepare reports to ensure that those systems are operated in a manner consistent with federal and State statutes and regulations.


Propose to technical staff overall schemes and specific parameters and defaults for system development and enhancements including reporting and evaluation.


·         Define data needs in user terms for system staff.

·         Provide test data and evaluate the results.

·         Develop, implement, and monitor system guidelines for users.

·         Train automated systems users in guidelines and procedures.

·         Identify problems and potential solutions with systems and notify user staff and technical staff.

·         May assist federal and State program audit and fraud and abuse staff.  Verify and explain program guidelines and parameters as well as assist in the selection of audit targets and outliers and the gathering of evidence and documentation.  Prepare responses to audits and implement corrective actions.


May supervise and train subordinate staff.


·         Assign work to subordinates and review all correspondence and reports for accuracy, completeness, and appropriateness.

·         Observe and evaluate subordinates in field assignments particularly in their effectiveness to advise local program managers and health care providers and to deal with recipients and the general public.

·         Prepare individual evaluations, annual ratings, and probation reports.




May perform any of the duties of a Medical Assistance Specialist 1 or 2.


Supervise and direct subordinate staff and oversee a significant unit or portion of the program.


·         Provide supervision, guidance, and oversight to subordinate staff, and intervene and resolve problems as necessary.

·         Determine and oversee staff assignments and activities, setting appropriate priorities.  Assure deadlines are met. 

·         Review, monitor, and evaluate staff performance, assuring good quality work products and timeliness. 

·         Identify training needs and arrange for provision of training.

·         May oversee contract staff directly or indirectly.


Interpret State and federal laws and regulations in order to develop instructions, policy statements, directives, analysis and other materials.


·         Direct the development and implementation of policies and procedures related to various aspects of the Medicaid program.

·         Interpret guidelines and instructions related to Medicaid issues.  Make recommendations and perform analysis for bureau and division-level staff as well as to the Governors office staff.  Write analytical reports and papers as required.

·         Work with technical and business systems and requirements analyst staff to develop automated systems programs and solutions. Assure an appropriate prioritization of projects and use of resources.

·         May serve as contact or liaison with federal Centers for Medicare and Medicaid staff and auditors, representing New York States interests and views.

·         Provide guidance to subordinate program staff and assistance to audit and fraud staff.

·         Direct staff efforts to assist federal and State audit staff in the application and interpretation of program guidelines and in the gathering of documentation and selection of audit targets.

·         Represent DOH and its public health insurance programs on various work groups, cross-functional teams and intra and inter-agency task forces concerned with Medicaid issues.

·         Analyze data relative to informing work group discussions and developing solutions.

·         Act as a leader in these groups, involving subordinate staff as appropriate and keeping supervisors and executive staff apprised of progress and issues that need higher level involvement.

·         Assure end products meet all State and federal requirements.

·         Serve as program expert and/or expert witness.




May perform any of the duties of lower-level Medical Assistance Specialists.


Direct, supervise, and oversee units of professional staff that have overall responsibility for Medicaid Program and other public health insurance programs payment, participation, and reimbursement policy governing a wide range of health care services accessed through the Medicaid Program.


·         Oversee staff analysis of Medicaid Program proposed and actual changes mandated by State and federal legislation and rule making, cost-saving initiatives and the improvement and updating of electronic systems.

·         Direct staff in responding to intra- and inter-agency correspondence, letters, telephone calls and emails from the public, clients, stakeholders, oversight agencies, federal staff, members of the Legislature, and health care provider community. 


Develop and make policy recommendations, and provide program evaluation, reports and feedback to necessary stakeholders.


·         Assist Executive staff in the development of health care reform and fiscal savings proposals, payment policy changes and revisions, and new approaches toward health care service delivery.

·         Seek input from stakeholders and interested parties.

·         Direct the implementation of new and revised policy as it pertains to the health care providers.


Assure that reimbursement policy is implemented consistent with State and federal requirements.


·         Direct staff in the communication of new and revised reimbursement and billing policies to regulated health care providers and professional organizations, as well as the State Fiscal Agent.

·         Assure that health care provider reimbursement mechanisms actually reflect appropriate and applicable payment policy.  Participate in the development of disaster recovery plans.

·         Direct program staff in gathering and analyzing data to assess and monitor Medicaid program costs, trends in service utilization, and quality of service delivery in support of policy development.


Serve as Medicaid program expert to Executive staff as well as in audit situations with State and federal auditors, and as an expert witness in criminal and civil actions.


·         Comment on proposed legislation and regulations emphasizing their impact on New York State, its public health insurance programs, and its health care industry.

·         Represent DOH, its public health insurance programs and New York State in meetings, public forums, conferences, and discussions concerning New York State Medicaid and other public health insurance reimbursement policy and procedures.  May serve as contact and liaison with federal oversight staff, federal auditors and investigators, and representatives of other states Medicaid programs.






Open-Competitive:  six years of professional experience performing one or more of the following activities, in a program that reimburses for health care services, provides health care services directly, provides health care regulatory oversight, or performs quality assurance and interpretation/application of standards of health care. 


Substitution:  college credit hours may be substituted for up to four years of qualifying experience at the rate of 30 college credits equaling one year of experience.




Promotion: one year of permanent competitive service as a Medical Assistance Specialist 1, Health Care Surveyor 2 (Nursing), Health Program Administrator, Medicaid Review Analyst 2 (Medical Care), Medicaid Review Analyst 2 (Surveillance and Utilization Review), or Senior Public Health Social Work Consultant.




Promotion: one year of permanent competitive service as a Medical Assistance Specialist 2, Health Program Administrator 1, Health Program Administrator 2, Medicaid Review Analyst 3 and various parenthetics, Traumatic Brain Injury Program Specialist, or WMS Installation Team Supervisor.




Promotion: one year of permanent competitive service as a Medical Assistance Specialist 3, Health Program Administrator 3, Health Program Administrator 4, Medicaid Review Analyst 4 (Surveillance and Utilization Review), or Program Research Specialist 4 (Human Services).




Date:  4/10



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.