Encounter Data Liaison (Medicaid Health Systems Administrator 2)
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Job Location:
Columbus, NE - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
The 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.
Compensation is as listed on the posting unless required by legislation or union contract.
This position is overtime exempt.
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.
What You Will Do at ODM:
Office: Data & Integrated Systems
Classification: Medicaid Health Systems Administrator 2 (PN )
Job Overview:
The Ohio Department of Medicaid is seeking a healthcare professional to be part of our EDI & Encounters Team. This position serves as a technical and policy liaison for post-adjudication encounter data reporting submitted by managed care plans. Also this position plays a critical role in ensuring data accuracy for rate setting policy compliance and quality care delivery. As the Encounter Data Liaison your responsibilities will include:
- Developing policy conducting program evaluation and supporting data-driven decision-making.
- Serving as the primary liaison for encounter data reporting and quality assurance.
- Leading bi-weekly meetings with managed care organizations (MCOs) to discuss:
- Delivery kick payments
- Encounter data quality metrics
- Quality-based assignments
- New initiatives such as NexGen MyCare
- Acting as the point person for the NexGen MyCare program launching 1/1/2026 coordinating across multiple departments.
- Supporting rate setting claims remittance investigations and financial team collaboration.
Interpreting and communicating data trends and anomalies to internal and external stakeholders.
The following qualifications are not required but are preferred for success in this role:
- Familiarity with X12 formats (e.g. 837 PACDRCA 270).
Proficiency in Medicaid data systems (i.e. MITS Vue360 and/or Administrator).
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 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.
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 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.
Completion of graduate core program in business management or public administration public health health administration social or behavioral science or public finance; 24 mos. planning & administering health services program or health services project management (e.g. health care data analysis health services contract management health care market & financial expertise; health services program communication; health services budget development HMO & hospital rate development health services eligibility health services data analysis).
-Or 24 months experience as a Medicaid Health Systems Administrator 1 65295. Note: education & experience is to be commensurate with approved position description on file.
-Or equivalent of Minimum Class Qualifications for Employment noted above.
Job Skills: Health Administration
Technical Skills: Public Health Data Analytics
Professional Skills: Collaboration Analyzation Interpreting Data Attention to Detail
Required Experience:
Unclear Seniority
Key Skills
- Computer Science
- Active Directory
- Computer information Technology
- PowerShell
- OS
- Windows
- Database
- SCCM
- Linux
- SAN
- Troubleshoot
- Backup
- Setup
- Technical Support
- UNIX
About Company
Ohio.gov is the official website for the State of Ohio. Find the government information and services you need to live, work, travel, and do business in the state.
