(Provider Compliance) Medicaid Health Systems Specialist

What You Will Do at ODM:

Office: Operations

Bureau: Network Management

Classification: Medicaid Health Systems Specialist (PN 20088910)

Job Overview:

The Ohio Department of Medicaid is seeking a compliance professional to be a part of our Network Management team. As a provider of compliance team member your responsibilities will include:

• Knowledge of Federal and State policy to ensure Medicaid provider compliance.

• Sending out documentation and BCI requests for prospective providers; notify them of noncompliance when documentation is not received

• Reviewing provider applications in their entirety, including but not limited to license limitations, BCI requirements, and additional supporting documents to meet enrollment requirements.

• Reviewing received BCIs and issue application denials for non-compliance and for applicants with disqualifying offenses

• Communicating regularly with the BCI office to check on missing BCIs

• Receiving work reports from State Sister Agency and complete actions as required on applications

• Frequently communicating (phone, email, etc.) with both providers and state sister agencies to resolve issues with applications to avoid provider abrasion and enrollment in a timely manner.

Completion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 24 mos. exp. specific to subject area of which 12 mos. exp. in use of spreadsheet and database software.

Note: education & experience to be commensurate with approved position description on file.

• Or 24 months experience as Medicaid Health Systems Analyst, (65291)
• Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.

Job Skills: Health Administration