Claims Review Specialist - Intermittent - Two Positions Medicaid Health Systems Specialist
Claims Review Specialist - Intermittent - Two Positions Medicaid Health Systems Specialist
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Job Description
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.
THIS POSITION IS INTERMITTENT & IS NOT TO EXCEED 1000 HOURS INA 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 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.
THIS POSITION IS UNCLASSIFIED PER 124.11 (A) 29 OHIO REVISEDCODE.
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.
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
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.
What You Will Do at ODM:
Office: Data & Integrated Systems
Bureau: Infrastructure & Operations
Classification: Medicaid Health Systems Specialist (PN&
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 desklevel 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 noncompliance or systemic issues in claims handling
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
Part-Time
