Estimated Length: 24 months M-F 9am-5pm

Requirements

Mission statement of OHIP:

The overall mission of the Office of Health Insurance Programs is to optimize the health of Medicaid members by wisely using all available resources.  OHIP is responsible for administering New York’s Medicaid budget by collaborating with stakeholders across the health care industry including other state agencies, local and federal government agencies, providers, members, and community-based organizations.  OHIP is also responsible for implementation of major initiatives including Medicaid Redesign, the Affordable Care Act, and State Administration of Medicaid.

Division functions:

Division of Medical and Dental Directors

The Division of Medical and Dental Directors (DMDD) is responsible to support and further strengthen the ability to coordinate medical and dental policy direction across all aspects of Medicaid, including managed care, fee-for-service, and waiver programs.

The DMDD Bureau of Medical Review performs Medicaid operational functions including prior authorization for durable medical equipment, medical supplies, private duty nursing services, hearing aids, and out-of-state hospital and skilled nursing facility admissions. The bureau is also responsible for the review and adjudication of Medicaid claims that pend for pricing, medical review, timeliness of submissions, and adherence to Medicaid claim submission policies. Additionally, the bureau operates a call center to answer inquiries from providers and members regarding prior approval policy and status.

Position Description:

The Auditor positions are located within DMDD, Bureau of Medical Review Call Center and Administrative Staff Support unit.  These positions have multiple responsibilities including, but not limited to:

• Answering telephone inquiries from healthcare providers, members caregivers and advocacy groups related to prior approval of medical services such as durable medical equipment, medical supplies, hearing aids, private duty nursing and out of state inquiries involving nursing home placement and other out of state procedures.
• Escalating complex inquires that cannot be answered with available information to appropriate staff
• Guiding and educating providers, as well as members, on where to locate pertinent policy information  
• Assisting providers to troubleshoot our prior approval system(s)
• Performing data entry into excel spreadsheets and other tracking tools
• Monitoring incoming emails and/or faxes from a shared mailbox and forward to the appropriate staff.
• Sending faxes through e-mail supported fax mailbox
• Distributing fair hearing request and decisions to appropriate staff
• Processing change request forms according to defined procedure
• Supporting claims processing when other duties are finished
• Maintaining a positive and professional demeanor always
• All other activities as may be deemed necessary

Additional Skill Level, Experience or Other Requirements:

• High School Graduate or Equivalent
• Experience with Microsoft Word and with Basic Excel functions
• Proficient in the use of standard office technology, to include fax machines, document scanners and copiers
• Ability to be flexible, innovative, and work in a team environment

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