Estimated Length: 24 months Monday-Friday / 8:30am to 4:30 pm

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 (approximately $65B for 2018) 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 Operations and Systems (DOS)

The Bureau of Medical Review, within the Division of Operations and Systems performs Medicaid operational functions including prior authorization for supplies and services, review of pended claims for pricing, timeliness of submissions and adherence to Medicaid claims submission policy and operation of a call center to answer inquiries from providers and members about prior approval. This division is also responsible for the oversight of the MMIS contracts (eMedNY, MDW, and future NYMMIS), the health benefit exchange (NYSoH), the EHR incentive program (MEIPASS), and it provides technical and contractual support for DSRIP implementation. The division oversees and manages the procurement, design, development, testing, implementation, security and ongoing operations for its systems, and manages integration with other systems such as WMS and Health Commerce. The division directly supports the implementation of HIPAA, the ACA and MRT in OHIP systems.

Position Description:

The Division of Operations and Systems, Bureau of Medical Pended Claims Review: The Administrative Assistant positions have multiple responsibilities including but not limited to:

• Review medical claims according to written procedures
• Escalate issues & complex claims
• Answer phones and transfer to the appropriate staff
• Educate providers on billing processes
• Educate providers on where to locate resources
• Maintain database for tracking purposes
• Data Entry
• Proficient in the use of several data bases
• File and maintain documents
• Fax, scan and copy documents
• Monitor incoming emails from a shared mailbox and forward to the appropriate staff
• Maintain a positive, profession demeanor always
• All other activities as may be deemed necessary
• Assist with special projects as assigned

Additional Skill Level, Experience or Other Requirements:

• High School Graduate or Equivalent
• Experience with Microsoft Word and Excel
• Proficient in the use of standard office technology
• Ability to be flexible, innovative and work in a team environment
• Previous claims experience preferred but not required

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