Eligibility Compliance Specialist Medicaid Health Systems Specialist
Eligibility Compliance Specialist Medicaid Health Systems Specialist
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Job Description
What You Will Do at ODM:
Office:Operations
Bureau:Business Operational Support
Classification: Medicaid Health Systems Specialist (PN
Job Overview:
The Ohio Department of Medicaid is seeking an experienced professional to work in our Eligibility Compliance Unit. As a Medicaid Health Systems Specialist your responsibilities will include:
- Monitor eligibility determinations and processes of County Departments of Job and Family Services (CDJFS) to ensure compliance with Medicaid rules
- Work with CDJFS to correct eligibility issues identified by business intelligence reporting and other Ohio Department of Medicaid work units
- Monitor reports to assist in the administration of Medicaid eligibility (application timeliness renewal timeliness and change processing) and assist in the creation of new monitoring reports
- Respond to inquiries from consumers agency staff stakeholders and staff from other agencies
- Work closely with CDJFS to complete corrective action plans
- Monitor eligibility determinations and processes of County Departments of Job and Family Services (CDJFS) to ensure compliance with Medicaid rules
The preferred candidate will have experience determining Medicaid eligibility monitoring compliance with Medicaid eligibility rules troubleshooting Medicaid eligibility issues and be proficient in Microsoft Excel.
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 drivers license from state of residence.
Resumes and/or attachments are not reviewed. Therefore please provide detail in the work experience section of your application.
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 DeWines agenda for Ohios 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 governors vision. As the single state Medicaid agency responsible for administering highquality personcentric 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.
Completion of undergraduate core program in business administration social or behavioral science health or statistics; additional 24 months experience specific to subject area of which 12 months experience in use of spreadsheet and database software.
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.
Note: education & experience to be commensurate with approved position description on file.
Job Skills: Health Administration
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 fulltime and parttime employees*. For a list of all the State of Ohio Benefits visit ourTotal Rewards website! Our benefits package includes:
- Medical Coverage
- Free Dental Vision and Basic Life Insurance premiums after completion of eligibility period
- Paid time off including vacation personal sick leave and 11 paid holidays per year
- Childbirth Adoption and Foster Care leave
- Education and Development Opportunities (Employee Development Funds Public Service Loan Forgiveness and more)
- Public Retirement Systems such as OPERS STRS SERS and HPRS&Optional Deferred Compensation Ohio Deferred Compensation
*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.
Ohio 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.
The State of Ohio is a drugfree workplace which prohibits the use of (recreational /nonmedical cannabis). Please note this position may be subject to additional restrictions pursuant to the State of Ohio DrugFree Workplace Policy (HR39 and as outlined in the posting.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
