Review Vacancy
AgencyMedicaid Inspector General, NYS Office of the
TitleDental Services Review Assistant 2
Occupational CategoryHealth Care, Human/Social Services
Bargaining UnitASU - Administrative Services Unit (CSEA)
Salary RangeFrom $59211 to $71412 Annually
Minimum Qualifications Current registration as a licensed Dental Hygienist in New York State and three years of experience in dental hygiene practice or graduation from a school of dentistry and one year of dental services experience.
Duties Description The duties of the position include, but are not limited to:
• Providing assistance in targeting and data review.
• Performing review and processing of pended professional dental or medical claims, assuring appropriate determinations.
• Performing research and data collection to support prepayment review actions.
• Assisting in building criteria to process dental claims.
• Manually reviewing treatment records for identified Dental Audits.
• Manually reviewing treatment records for identified Dental System Match and Recovery Projects.
• Monitoring the billing patterns and practices of identified dental providers.
• Utilizing professional judgment to document and critique the quality of care provided to the Medicaid patients of identified Medicaid Providers.
• Assisting with dental research-related projects.
• Preparing Provider review summaries and referrals for action based on NYS Dental Medicaid Rules, Regulations, Policies, and Guidelines.
• Providing official expert testimony on behalf of New York State during administrative hearings and court proceedings.
• Defending the professional judgment utilized during investigations, claim reviews, system match projects, and audits of identified Medicaid Providers.
• Utilizing professional dental expertise to provide OMIG with a critique of a Provider’s practice when suspected inappropriate performance is identified.
• Providing professional expertise to OMIG staff as requested.
• Communicating orally and in writing with Dental Medicaid Providers, OMIG legal staff, independent peers, other agencies, the provider community, and their legal counsel as necessary.
• Travelling, if necessary, to consult, examine records or documents, and testify.
• Working with OMIG program and system staff as necessary.
Additional Comments Experience in the review of dental records and prepayment claims review and/or audit experience, basic computer skills such as Microsoft Access, Excel, and Word. A clear understanding of the NYS Dental Medicaid program rules, regulations, and guidelines is preferred.
Some positions may require additional credentials or a background check to verify your identity.