Auditors

Job Description

Job Description

JOB-20850 Auditors - 25910

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 :

The Division of Medical and Dental Directors (DMDD) is responsible for supporting and further strengthening 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.

Position Description :

The Auditor position is located within DMDD, Bureau of Medical Review Pended Claims unit. This position has multiple responsibilities including, but not limited to:

• Review of 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 databases
• 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

\nCompany Description

Established in 2005, Knowledge Builders Inc. (KBI) offers a wide range of services, including Information Technology Consulting, Administrative and Health Care Staffing solutions, Payrolling, and Call Center services to organizations of all sizes, including both private companies and governmental entities. KBI is a certified Woman-Owned Business Enterprise (WBE) recognized by New York State, New York City, and the Port Authority of New York and New Jersey.

Our extensive consultant placements cover a variety of roles, from Technical Architects and Specialists to Developers, Project Managers, Analysts, Executive Secretaries, Nurses, Dietitians, Paralegals, Computer Operators, Food Preparation Workers, and many other occupations. To date, KBI has successfully placed over 1,000 consultants across more than 100 private sector companies and public sector agencies in New York State and throughout the country.

We are dedicated to recruiting candidates who consistently exceed our customers’ expectations.

We provide equal employment opportunity for all applicants and employees regardless of race, color, sex, gender identity, gender expression, religion, age, national origin, citizenship, disability, medical condition, family care status, marital status, domestic partner status, sexual orientation, genetic information, military/veteran status, or any other protected basis.

Company Description

Established in 2005, Knowledge Builders Inc. (KBI) offers a wide range of services, including Information Technology Consulting, Administrative and Health Care Staffing solutions, Payrolling, and Call Center services to organizations of all sizes, including both private companies and governmental entities. KBI is a certified Woman-Owned Business Enterprise (WBE) recognized by New York State, New York City, and the Port Authority of New York and New Jersey.\r\n\r\nOur extensive consultant placements cover a variety of roles, from Technical Architects and Specialists to Developers, Project Managers, Analysts, Executive Secretaries, Nurses, Dietitians, Paralegals, Computer Operators, Food Preparation Workers, and many other occupations. To date, KBI has successfully placed over 1,000 consultants across more than 100 private sector companies and public sector agencies in New York State and throughout the country.\r\n\r\nWe are dedicated to recruiting candidates who consistently exceed our customers’ expectations.\r\n\r\nWe provide equal employment opportunity for all applicants and employees regardless of race, color, sex, gender identity, gender expression, religion, age, national origin, citizenship, disability, medical condition, family care status, marital status, domestic partner status, sexual orientation, genetic information, military/veteran status, or any other protected basis.