Staffing Solutions Organization LLC (SSO), an affiliate of Public Consulting Group LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve. **Healthcare Program Associate - Albany, NY** **DMDD - 1317** **Summary** The Division of Medical and Dental Directors, Bureau of Medical Review is recruiting for Healthcare Program Associate to assist the Bureau in day-to-day operations for the Pended Claims Unit. The Bureau of Medical Review is responsible for prior approval and pre-payment review of medical equipment and service, policy development as well as fraud and abuse monitoring for the New York State Medicaid System. The Pended Claims Unit focuses on process improvement resulting in cost savings and staff efficiencies. **Responsibilities include:** + Using established instructions perform complex medical claims adjudication, including pricing of claims. + Handle complex phone calls regarding pended claim issues and promptly respond to provider inquires. + Supervise and train subordinate staff in claims review and perform quality assurance reviews to maintain accuracy and consistency of claims reviews. + All other activities necessary to maintain defined regulatory claims review timelines. **Preferred Qualifications:** + Proficient in the use of standard office technology + Excellent organizational skills including the ability to prioritize work assignments + Ability to be flexible, innovative, and work independently with minimal supervision and as a team lead + Strong communication skills (written and verbal) with the ability to handle internal and external calls/inquiries + Maintains a positive, professional demeanor + Previous customer service experience **Basic Qualifications:** + Associate Degree + 6 months experience in healthcare field _*Employees must follow established work schedules. The usual work schedule is 37.5 hours per week, Monday through Friday. Normal work hours are 8:30 a.m. to 4:30 p.m. unless otherwise specified by the supervisor, this includes a half hour unpaid lunch break. Total work hours must equal 37.5 hours per week._ Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides a reasonable range of compensation for this role. In addition, SSO provides a range of benefits for this role. Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an Employment Visa at this time. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an e-Verify participant. **Job Details** **Pay Type** **Hourly** **Education Level** **Equivalent Experience** **Telecommute Percentage** **50** **Hiring Min Rate** **19 USD** **Hiring Max Rate** **22 USD**