ECLARO · 1 day ago
Auditors
Albany, NY
Contract
Onsite
New Grad, Entry LevelECLARO is looking for Auditors for their client in Albany, NY, who aims to enhance public services and promote sustainable resource management. The role involves providing clerical and administrative support to the Prior Approval Units, including handling Fair Hearing packets and processing medical claims.
Staffing & Recruiting
Responsibilities
Providing clerical and administrative support to the Prior Approval Units, including the preparation, organization, and assembly of Fair Hearing packets that need to be mailed to members, representatives and providers
Reviewing Fair Hearing packets for completeness and inclusion of all required documentation prior to distribution
Scanning and uploading all Fair Hearing documents for processing
Processing packages for mailing within required timeframes
Performing medical claims pricing for medical pended claims
Reviewing invoices, applying established pricing methodologies, and performing accurate calculations in accordance with Medicaid reimbursement rules
Entering pricing determinations and related data into the eMedNY system with high degree of accuracy and attention to detail
Identifying discrepancies, missing documentation, or potential billing issues and escalating appropriately
Conducting initial and basic reviews of requests for durable medical equipment and medical supplies using established criteria
Escalating cases that fall outside of standard criteria to clinical staff (therapists, nurses, or other designated professionals) for further review and determination
Responding to basic inquiries from providers and members via phone and email regarding prior approval status, documentation requirements, and general policy guidance in a clear, professional and courteous manner
Adhering to established workflows, turnaround times, and performance standards to support bureau-wide service level goals
Review medical claims according to written procedures
Escalate issues & complex claims
Answer phones and transfer to the appropriate staff
Educate providers on billing processes
Educate providers on where to locate resources
Maintain database for tracking purposes
Data Entry
Proficient in the use of several databases
File and maintain documents
Fax, scan and copy documents
Monitor incoming emails from a shared mailbox and forward to the appropriate staff
Maintain a positive, profession demeanor always
All other activities as may be deemed necessary
Assist with special projects as assigned
Qualification
Required
High School Diploma or equivalent
Experience with Microsoft Word and Excel
Proficient in the use of standard office technology
Basic knowledge of medical terminology
Ability to be flexible, innovative, and work in a team environment
Strong written and verbal communication skills
Preferred
Previous claims experience
Benefits
401k Retirement Savings Plan administered by Merrill Lynch
Commuter Check Pretax Commuter Benefits
Eligibility to purchase Medical, Dental & Vision Insurance through ECLARO
Company
ECLARO
ECLARO is an award-winning professional services firm headquartered in New York City and operating in the U.S., Canada and the Philippines.
Founded in 1999
1001-5000 employees
H1B Sponsorship
ECLARO has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (1)
2024 (1)
2023 (1)
2022 (2)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Nicholas Butcher
QA CTO Label Specialist
Dan Broderick
Chief Delivery Officer
Company data provided by crunchbase