Physical Therapists

US: Tryfacta • Buffalo, NY

1d

About The Position

Tryfacta is seeking a Physical Therapist for a 24-month contract assignment with its client in Albany, New York. The position is with the Division of Medical and Dental Directors, specifically the Bureau of Medical Review, which performs Medicaid operational functions including prior authorization and review of claims. The work schedule is Monday through Friday, 8:30 a.m. to 4:30 p.m., and the listed pay rate is $65–$70 per hour.

The Physical Therapist conducts comprehensive reviews of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) requests for Medicaid members to determine whether requested services are covered under the Medicaid Program and New York State regulations. The role uses professional clinical knowledge and judgment to assess whether requested items meet an individual's medical needs. It also participates in Fair Hearings by preparing written supporting evidence and representing the New York State Medicaid Prior Approval Department by telephone. The position involves applying relevant regulations and national procedure and diagnosis coding standards, communicating with physicians, outside stakeholders, and Medicaid members, and helping identify ways to prevent fraud and abuse.

Requirements

• Current license/registration.
• Excellent oral and written communication skills.
• Experience in prior approval of medical supplies, equipment, or services, or experience examining medical records, documentation, and proposed treatment plans for medical necessity.
• Experience evaluating and making recommendations for various DME and writing medical justifications.
• Experience with Microsoft Office.
• Proficiency in standard office technology.
• Ability to be flexible, innovative, and work in a team environment.
• Willingness to work weekend hours if needed.

Responsibilities

• Review DMEPOS requests for Medicaid members to determine coverage under the Medicaid Program and New York State regulations.
• Use clinical knowledge and judgment to determine whether requested items are appropriate to meet individual medical needs.
• Participate in the Fair Hearing process by preparing written supporting evidence and representing the NYS Medicaid Prior Approval Department by telephone.
• Apply relevant regulations and national standards for procedure and diagnosis coding when reviewing requests.
• Review appropriate combinations of medical services and help identify methods to prevent fraud and abuse.
• Communicate with physicians, outside stakeholders, and Medicaid members through written and telephone correspondence.

What This Job Offers

• Education Level: No Education Listed