Prior Approval Specialist-25448
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Job Location:
Albany, GA - USA
Monthly Salary:
$ 22 - 22
Posted on:
2 days ago
Vacancies:
1 Vacancy
Job Summary
Job Description
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 Yorks 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 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:
These positions are located within DMDD Bureau of Medical Review Pended Claims unit. These 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
Required Experience:
IC
Key Skills
- Sales Experience
- Crane
- Customer Service
- Communication skills
- Heavy Equipment Operation
- Microsoft Word
- Case Management
- OSHA
- Team Management
- Catheterization
- Microsoft Outlook Calendar
- EHS
About Company
Who We Are & What We Do Established in 2005, Knowledge Builders Inc. (KBI) provides Information Technology Consulting, Administrative and Health Care Staffing solutions, Payrolling and Call Center services to companies and governmental entities of all sizes. KBI is a Woman-Owned Bus ... View more
