Auditor

Mission statement of OHIP :

Division functions :

Division of Medical and Dental Directors

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 :

The Auditor positions are located within DMDD, Bureau of Medical Review Pended Claims unit and Administrative Staff Support 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