Medicaid Eligibility Examiner 4

Grade 21

New York State has approximately 43 positions* in this title statewide. You may view a breakdown of positions by county. This position exists in Health, Department of. View links to all New York State agencies including agencies that have this title. For more information, New York State employees can contact the Career Mobility Office at (518) 485-6199 or (800) 553-1322. If you are not a current New York State employee, you can use the Department of Civil Service Web site to explore possible employment opportunities.

*The number of positions is approximate and represents the number of positions established (both filled and vacant); it is not an indication or reference to position type or duration, or intent to be filled. If you are viewing a trainee title, please note this number reflects the number of positions established at the journey level. Agencies may fill at the trainee level(s) or at the journey level based on employee qualifications. GOT-IT does not provide information on any job postings or job availability. For information on current job postings, please visit State Jobs NY. You may also visit specific New York State Agency websites for information about an agency and its job opportunities.

Career Ladder

A listing of titles that are most commonly used as steps for upward mobility for this title series. The salary schedule for this career ladder is also available.

  1. Medicaid Eligibility Examiner Trainee

    Similar to Grade 06

  2. Medicaid Eligibility Examiner 1

    Grade 09

  3. Medicaid Eligibility Examiner 2

    Grade 14

  4. Medicaid Eligibility Examiner 3

    Grade 17

  5. Medicaid Eligibility Examiner 4

    Grade 21

Summary of Job Description

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.

View the classification standard for this title, on the Classification and Compensation webpage.

The NYS Title and Salary Plan provides additional information regarding other titles. If there is a classification standard available there will be a link under the column labeled STD. NO. If no link is available there is no classification standard available at this time for that title.

Summary of Minimum Qualifications

Please note: qualifications for this position may be subject to change. If substitutions for education and/or experience are allowed, this information would be available on the announcement.

You must take and pass a Civil Service examination in order to be considered for this position.  

On or before the date of the examination, the candidate 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.


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


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;


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;


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


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


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.

For informational purposes only, click on the examination number(s) listed below to see the current or previous examination(s) that are used to fill this title.

38-979 80-196

How to Apply

When this examination is scheduled to be held, the announcement can be found on the Department of Civil Service, Examination Announcements web page. If you do not see an examination currently scheduled please check back on a monthly basis or sign up for announcement notification by email so that you will automatically be notified when new examinations are being offered.

Career Mobility

Career mobility is not just limited to the titles in the Career Ladder, above. Additional movement may be achieved through other examinations, additional education and/or work experience or transfer opportunities. For additional information or clarification of transfer determinations, current State employees should contact the Career Mobility Office. Visit ELMS Online to view established open-competitive, promotion, and transition eligible lists. If you are not a current New York State employee, see Employment Opportunities with New York State and find out how to become a New York State employee.

back to top