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All positions are located at: 4345 N. Lincoln Blvd Oklahoma City, Oklahoma 73105

You must submit a signed OHCA Employment Application (PDF) (click for Microsoft Word version) and any additional documents if required for each position applied to electronically via email or fax.  

Please submit the Equal Employment Opportunity Commission (EEOC) form (click for Microsoft Word version) as well; the form is optional. 

Submit your application and other documents via email or fax with the following information:

Oklahoma Health Care Authority
personnel@okhca.org
Fax#: (405) 530-7218

You can email or fax your application. Applications must be electronically received no later than the 5:00 p.m. CST on the announcement closing date.


Applicants will be contacted via the email address listed on their application.

 

The Oklahoma Health Care Authority is accepting applications for the following position(s):

Announcement Number:1907004
Application Deadline:7/31/2019
Position Title:Medical Audit Specialist
Number of Vacancies:2
Division:Clinical Provider Audits
Annual Salary:$61,717.00
Summary:
Act as the clinical specialist to the Provider Audits staff when analyzing traditional fee for service and managed care claims related to federal and state regulations.
Typical Functions May Include:
  • Provides clinical expertise in all Provider Audits regarding all general providers/issues.
  • Performs verification of credentials of providers in conjunction with Provider Audits to ensure HCA policy requirements are met.
  • Develops and maintains audit criteria for Provider Audits.
  • Performs Provider Audits of billed services, including charges and documentation to ensure all HCA policy requirements are met and services are clinically/medically appropriate.
  • Assists Provider Audits analyst in the evaluation and interpretation of billed charges and clinical documentation to ensure all HCA policy requirements are met and services are clinically/medically appropriate.
  • Develops and provides training related to issues identified by the Provider Audits staff as needed.
  • Represents the Provider Audits Unit before an ALJ and in legal proceedings regarding any general provider appeals.
  • Reviews audit results of providers performed by other state agencies and make Provider Audits referrals as appropriate.
  • Makes a policy recommendation to the Policy Unit, as policy issues are identified during Provider Audits.
  • May be required to provide expert testimony in court proceedings.
  • Performs related work as required and assigned.TRAVEL: Travel on an “as needed” basis.
Education/Experience Requirements:
  • Current, valid RN license and
  • 3 years clinical experience and
  • At least 1 year experience in medical review, auditing, utilization review, compliance or regulatory work.
  • General understanding of coding principles (CPT, HCPCS, ICD-9-CM and/or DRG)
Preference May Be Given To Candidates With:
  • SoonerCare experience
  • Experience with claims review or billing
  • Experience in auditing, QA/QI or utilization review setting
  • Advanced education
Additional Required Documents


   Important: You must submit all required documents to be considered for this position.
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