Medicaid Enrollment Processors (Auditors)

JOB-20756 Auditors - 25872

Title: Auditor

Department: Department of Health (DOH)

Office: Office of Health Insurance Programs (OHIP)

Division: Division of Operations and Systems

Location: 11 Corporate Woods, Albany, 3rd FL

Shift/Schedule: 37.5 - 40 hours, between the hours of 7:30 – 4:30 (30 min unpaid break). After training and upon approval of bureau management, telecommuting up to 50% of the pay period may be available.

Employees are requested to refrain from taking time off during the initial training period, up through the first 90 days to ensure the best learning outcomes.

Mission statement of OHIP:

The overall mission of the Office of Health Insurance Programs (OHIP) is to optimize the health of Medicaid members by wisely using all available resources. OHIP is responsible for state administration of the Medicaid program and for administration of New York’s Medicaid budget by collaborating with stakeholders across the health care industry including other state agencies, local and federal government agencies, providers, members, and community-based organizations.

Division functions:

The Division of Operations and Systems (DOS) is responsible for the oversight of information systems that support the New York State Department of Health initiatives as well as the New York State Medicaid Program.

The initiatives include, but are not limited to, the NY State of Health (NYSOH) system, the Medicaid Eligibility and Client Management (MECM) system, the electronic Medicaid of New York State (eMedNY) system, the Medicaid Provider Services Portal (PSP), and the Medicaid Data Warehouse (MDW). The division's duties include oversight of the design, development, testing and implementation of the enhancements to these systems.

Position Description:

This is a full-time position with the NYS Medicaid Program’s Bureau of Provider Enrollment (BPE). BPE staff are responsible for enrolling, revalidating, and maintaining Medicaid provider files in the eMedNY system and/or in the Provider Services Portal (PSP). This includes:

• Ensuring that applications and required documentation submitted in the PSP are complete, current, and valid, and that data entered into the PSP complies with federal and State requirements, policies and procedures.
• Navigating various federal and State databases, including Medicare’s enrollment system (PECOS), the NPI Registry (NPPES), the New York State Education Department’s (NYSED’s) Office of the Professions Verification Search, and other states’ licensing verification websites, to verify information supplied on an application is current and valid.
• In a clear, concise, and professional manner, contacting providers via the PSP, email, or phone if information is incomplete or requires further clarification.
• Entering and updating provider information in eMedNY and/or the PSP.
• Meeting production and quality standards.
• Filing, maintaining, and uploading documents according to procedures.

Additional Skill Level, Experience or Other Requirements:

• Previous experience reviewing, verifying, validating detailed/sensitive information using web-based verification sources (Preferred)
• Data entry experience (Preferred)
• Strong computer skills, including proficiency in Microsoft Office, internet navigation
• Strong communication skills (written and verbal)
• Previous customer service experience
• Excellent organizational skills
• Ability to be flexible, innovative, work independently, recognize and manage priorities with minimal supervision and as a team member
• High school graduate or equivalent

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