THIS POSITION IS INTERMITTENT & IS NOT TO EXCEED 1,000 HOURS IN A STATE FISCAL YEAR
About Us:
Investing in opportunities for Ohioans that work for every person and every family in every corner of our state is at the hallmark of Governor DeWine’s agenda for Ohio’s future. To ensure Ohio is “the best place to live, work, raise and family and start a business,” we must have strong schools, a great quality of life, and compassion for those who need our help.
Ohio Department of Medicaid plays a unique and necessary role in supporting the governor’s vision. As the single state Medicaid agency responsible for administering high-quality, person-centric healthcare, the department is committed to supporting the health and wellbeing of nearly one in every four Ohioans served. We do so by:
Delivering a personalized care experience to more than three million people served.
Improving care for children and adults with complex behavioral health needs.
Working collectively with our partners and providers to measurably strengthen wellness and health outcomes.
Streamlining administrative burdens so doctors and healthcare providers have more time for patient care.
Ensuring financial transparency and operational accountability across all Medicaid programs and services.
What You Will Do at ODM:
Office: Data & Integrated Systems
Bureau: Infrastructure & Operations
Classification: Medicaid Health Systems Specialist (PN 20102361 & 20102362)
Job Overview:
The Ohio Department of Medicaid (ODM) is seeking healthcare professionals to be part of our Claims Resolution Outreach Team. As a Claims Review Specialist, your responsibilities will include:
reviewing and auditing medical claims submitted to ODM and processed by contractors
ensuring compliance with state reimbursement rules, desk-level procedures, and applicable federal and state policies
evaluating adherence to billing standards and identifies underpayments, overpayments, or processing discrepancies
assessing contractor performance against processing standards and contractual obligations
verifying claims compliance with applicable federal and state regulations (e.g., Medicaid, Medicare)
identifying patterns of non-compliance or systemic issues in claims handling
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:
*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.
-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.
Job Skills: Health Administration
Technical Skills: Public Health
Professional Skills: Customer Focus, Analyzation, Attention to Detail, Collaboration
Supplemental InformationTHIS POSITION IS UNCLASSIFIED PER 124.11 (A) (29), OHIO REVISED CODE.
Compensation is as listed on the posting unless required by legislation or union contract.
Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence.
Resumes and/or attachments are not reviewed. Therefore, please provide detail in the work experience section of your application.
ADA StatementOhio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.
Drug-Free WorkplaceThe State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.
