Medicaid Quality Control Analyst (Case Management Analyst)

What You Will Do At ODM:

Office: Legal Counsel

Bureau: Program Integrity

Classification: Case Management Analyst (PN: 20042098)

Job Overview:

The Ohio Department of Medicaid (ODM) is seeking a Medicaid Quality Control Analyst to be part of our Medicaid Eligibility Quality Control (MEQC) unit. This person will complete quality control reviews of Medicaid eligibility determinations made by county departments of Job and Family Services, to ensure timeliness and accuracy statewide. As a Medicaid Quality Control Analyst, your responsibilities will include:

• Conducting comprehensive case reviews of County Departments of Job and Family Services (CDJFS) and other participating agencies' records that determine eligibility for Medicaid programs.
• Reviewing approval/denials of random selected CHIP and Medicaid cases to evaluate the eligibility determination accuracy.
• Analyzing automated computer information systems to ensure county compliance with federal and state rules, regulations, and policies.
• Verifying all aspects of Medicaid eligibility by reviewing case record information, electronic verifications, and eligibility system actions.
• Making a final determination at the conclusion of the case review findings and providing results and analysis of reviews.
• Ensuring compliance with federally mandated MEQC rules and regulations.
• Communicating with ODM leadership about issues identified during reviews.

The preferred candidate will have a background in Medicaid eligibility and possess strong analytical skills with attention to detail.

Completion of undergraduate core coursework in social &/or behavioral science; 12 mos. trg. or 12 mos. exp. in public assistance regulations & policies relative to all public assistance programs; 3 mos. trg. or 3 mos. exp. in technical writing; 3 mos. trg. or 3 mos. exp. in mainframe databases; valid Ohio driver's license.

• Or 36 mos. exp. as public assistance caseworker, with experience in all categories of public assistance; 3 mos. trg. or 3 mos. exp. in technical writing; 3 mos. trg. or 3 mos. exp. in mainframe databases; valid Ohio driver's license.
• Or equivalent of Minimum Class Qualifications for Employment noted above.

Technical Skills: Health Administration

Professional Skills: Attention to Detail, Collaboration, Interpreting Data, Results Oriented, Verbal Communication, Written Communication