Physical Therapists

New Wave People•Albany, NY

1d•Onsite

About The Position

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.

Requirements

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
Proficient in the use of standard office technology
Ability to be flexible, innovative, and work in a team environment
NYS Unrestrictive License Required
Proper footwear required to perform tasks in a safe manner.

Nice To Haves

Willing to work weekend hours if needed

Responsibilities

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.
Use professional clinical knowledge and judgement 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.
Utilize national standards for procedure and diagnosis coding.
Review appropriate combinations of medical services.
Identify methods to prevent fraud and abuse.
Work closely with physicians, outside stakeholders, and Medicaid members via written and telephonic correspondence.
Perform other reasonably related duties as required.