Full employer posting
Department: Department of Health (DOH) Office: Office of Health Insurance Programs (OHIP) Division: Division of Medical and Dental Directors (DMDD) Location: One Commerce Plaza, Albany, NY 12260 Position Description: Conduct comprehensive review of DMEPOS requests for Medicaid members to determine if the service falls within the scope of coverage of the Medicaid Program and NYS Regulation. Professional clinical knowledge and judgement used to render decisions that ensure the requested item is appropriate to meet the individual’s medical needs.
Actively involved in the Fair Hearing process by providing supporting evidence in written format and represents the NYS Medicaid Prior Approval Department via telephone. Knowledgeable of NYCRR Title 10 and 18 regulations. Utilizes national standards for procedure and diagnosis coding, reviews appropriate combinations of medical services and is instrumental in identifying methods to prevent fraud and abuse.
Works closely with physicians, outside stakeholders, and Medicaid members via written and telephonic correspondence. Additional Skill Level, Experience or Other
Current license/registration Excellent oral and written skills required. Experience in prior approval of medical supplies/equipment/services or experience in examination of medical records, documentation, and proposed treatment plans for medical necessity Experience in evaluating, making recommendations, and writing medical justification for various DME Experience with Microsoft Office Willing to work weekend hours if needed Proficient in the use of standard office technology Ability to be flexible, innovative, and work in a team environment