About US: Tryfacta is a leading, nationally renowned Workforce Management Solution provider for private &public sector firms across the US. We specialize in Healthcare, IT, Business Support, and Professional & Craft/Light Industrial ecosystems.
Founded in March 1996, we have a presence in all 50 States. Tryfacta has Ranked number 1 as one of the fastest-growing companies by Inc. Magazine (Inc. 5000)!
Tryfacta is certified by the Joint Commission for Healthcare Staffing Services & has numerous ISO Certifications that capture our commitment to continuous improvement.
Job Summary:
Tryfacta is seeking a Physical Therapists for our client in Albany, NY 14202. This is a 24 month contract assignment. If you meet the qualifications listed below and are interested, please Apply Now!
Job Diva ID: 26-05520 Position Title: Physical Therapists Location: Albany, NY 14202. Duration: 24 months Work Schedule: Monday-Friday, 8:30-4:30 Pay rate: $65 - $70/hr.
Responsibilities for this position include, but are not limited to:
Division of Medical and Dental Directors (DMDD)
The Division is responsible for the prior approval and pended claims functions for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), private duty nursing, hearing aids, vision care, and dental. The Division also manages the prior approval process for out-of-state nursing home placements, high tech radiology, the Center for Operational Excellence, and the Medical Indemnity Fund. The Bureau of Medical Review, within the Division of Medical and Dental Directors, performs Medicaid operational functions including prior authorization for supplies and services, review of pended claims for pricing, timeliness of submissions and adherence to Medicaid claims submission policy, prior authorization for Fee for Service (FFS) Medicaid members seeking admission to skilled nursing facilities out of state, and operation of a call center to answer inquiries from providers and members about prior approval.
Position Description:
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.
Additional Skill Level, Experience or Other 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
Willing to work weekend hours if needed
Proficient in the use of standard office technology
Ability to be flexible, innovative, and work in a team environment
Tryfacta is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Numbers & Facts
Location
Buffalo,, NY
Salary
$65–$70 Per Hour
Skills
Business Supportunmatched
Call Center Operationsunmatched
Code Reviewsunmatched
Continuous Improvementunmatched
Documentationunmatched
Durable Medical Equipmentunmatched
Ecosystemsunmatched
Equipment Maintenance/Repairunmatched
Governmentunmatched
Health Information Technologyunmatched
Healthcareunmatched
ISO (International Organization for Standardization)unmatched
Medicaidunmatched
Medical Equipmentunmatched
Medical Productsunmatched
Medical Recordsunmatched
Medical Treatmentunmatched
Medical Writingunmatched
Microsoft Officeunmatched
Nursingunmatched
Nursing Homeunmatched
Orthoticsunmatched
Physical Therapyunmatched
Presentation/Verbal Skillsunmatched
Pricingunmatched
Prostheticsunmatched
Radiologyunmatched
Regulationsunmatched
Telephone Skillsunmatched
The Joint Commission (TJC)unmatched
Treatment Planunmatched
Workforce Managementunmatched
Writing Skillsunmatched
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