Auditors

Auditor

Employment Type: Contract

Work Hours: 40 hrs./week Work site: 100% Onsite

Location: 99 Washington Ave, Albany, NY 12210

Job Duration: 2 Years Closing: 01/28/2026

Position Description

The Auditor positions are located within DMDD, Bureau of Medical Review, Durable Medical Equipment, and Medical Supplies Prior Approval units. These positions have multiple responsibilities including, but not limited to:

• Providing clerical and administrative support to the Prior Approval Units, including the preparation, organization, and assembly of Fair Hearing packets that need to be mailed to members, representatives and providers.
• Reviewing Fair Hearing packets for completeness and inclusion of all required documentation prior to distribution.
• Scanning and uploading all Fair Hearing documents for processing.
• Processing packages for mailing within required timeframes.
• Performing medical claims pricing for medical pended claims.
• Reviewing invoices, applying established pricing methodologies, and performing accurate calculations in accordance with Medicaid reimbursement rules.
• Entering pricing determinations and related data into the eMedNY system with high degree of accuracy and attention to detail.
• Identifying discrepancies, missing documentation, or potential billing issues and escalating appropriately.
• Conducting initial and basic reviews of requests for durable medical equipment and medical supplies using established criteria.
• Escalating cases that fall outside of standard criteria to clinical staff (therapists, nurses, or other designated professionals) for further review and determination.
• Responding to basic inquiries from providers and members via phone and email regarding prior approval status, documentation requirements, and general policy guidance in a clear, professional and courteous manner.
• Adhering to established workflows, turnaround times, and performance standards to support bureau-wide service level goals.

Additional Skill Level, Experience or Other Requirements

• High School Diploma or equivalent required
• Experience with Microsoft Word and Excel
• Proficient in the use of standard office technology
• Basic knowledge of medical terminology
• Ability to be flexible, innovative, and work in a team environment
• Strong written and verbal communication skills
• Previous claims experience preferred but not required

Miscellaneous Information

• Shift Days/Time: Monday to Friday, 9 AM to 5 PM.
• Bus transportation options are available.
• Parking charges are dependent on where the incumbent parks (City Streets, Commuter Lots, etc...)
• Interviews will be conducted in-person or online based on the availability.
• $13 for ID badge (paid by check).
• Training will be provided.

The Nexus Staff Difference

• Our outstanding healthcare coverage, including dental and vision, begins in just 30 days after you join us.
• We offer weekly payments via ACH (Automated Clearing House).
• Serving as Prime Vendors to New York State and New York City for over 10 years.