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 We are committed to providing equal employment opportunities to all employees and applicants without regard to race, religion, color sex, national origin, citizenship status, age, sexual orientation, gender identity, marital status, uniform service member status, genetic information, disability, or any other protected status, in accordance with all applicable federal, state, and local laws. This practice extends to all aspects of our employment practices, including but not limited to, recruiting, hiring, firing, promoting, transferring, compensation, benefits, training, leaves of absence, and other terms and conditions of employment.

　　Minimum Salary: 31200.00Maximum Salary: 31200.00Salary Unit: Yearly