Medical Audit Specialist

Recruitment #210407-UNCA-06

Introduction

A resume and cover letter must be submitted with your application.

The Office of Management and Enterprise Services (OMES) is dedicated to providing excellent service, expert guidance, and continuous improvement in support of our partners’ goals. We are a highly-qualified workforce committed to serve those who serve Oklahomans and make government run in the most efficient, innovative manner possible. Achieving this mission takes a collaborative, agile, respectful team with humble leaders who make a difference and get things done. 

For more information about OMES, please visit our website.  

OMES is seeking a full time Medical Audit Specialist with the Employees Group Insurance Division (EGID). This is an unclassified position in state government, located in Oklahoma City. OMES offers a comprehensive Benefits Package, including a generous benefit allowance to offset the cost of insurance premiums for employees and their eligible dependents.  For more information about the benefit allowance [click here]. The annual salary for this position is up to $80,000.00 based on education and experience.

This position will act as the clinical specialist when analyzing health and dental care claims pertaining to the programs offered by the Office of Management and Enterprise Services (OMES) Employees Group Insurance Division (EGID) for purposes of detecting abnormal billing situations, including but not limited to fraud, waste and abuse.

Position Responsibilities
•Assist in the evaluation and interpretation of billed charges and clinical documentation and performs provider audits of billed services (including charges and documentation) to ensure all EGID policy requirements are met and services are clinically/medically appropriate. Works with Chief Medical Officer, Network Management and Legal as necessary.
•Perform verification of credentials of providers in conjunction with provider audits to ensure EGID policy requirements are met.
•Develop and maintains audit criteria for provider audits.
•Develop and provides training related to issues identified by provider audits as needed.
•Review audit results of providers performed by other state agencies and make provider audits referrals as appropriate.
•Make policy recommendations to the Policy Research Unit, as policy issues are identified during provider audits.
•May be required to provide expert testimony in proceedings.
•Demonstrate general understanding of coding principles (CPT, HCPCS, ICD-9-CM and/or DRG)
•This position has no supervisory responsibilities.

Physical Demands and Work Environment
This position works in a comfortable office setting with a computer for a large percentage of the workday. The noise level in the work environment is usually mild. Occasional travel may be required.

OMES is an Equal Opportunity Employer. Reasonable accommodation to individuals with disabilities may be provided upon request.

MINIMUM QUALIFICATIONS

Requirements include a current valid license as a Registered Nurse in the State of Oklahoma, 3 years clinical experience, and 1 year of experience in medical review, auditing, utilization review, compliance or regulatory work.

Preference my be given to candidates who possess CPC certification.

NOTES

Please read instructions carefully and include all required documents when you submit your application.

No additional information will be accepted after the application has been submitted.

Conclusion

Veteran’s preference points apply only for initial appointment in the classified service.