Provider Engagement Specialist (Medicaid Health Systems Specialist)

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: Operations

Bureau: Network Management

Classification: Medicaid Health Systems Specialist (PN 20046417)

 

Job Overview:

As a Provider Engagement Specialist on the Provider Relations team at the Ohio Department of Medicaid (ODM), your responsibilities will include:

·         Review and research provider complaints that are submitted through HealthTrack in addition to ensuring Managed Care Organizations (MCOs), MyCare, and OhioRISE are meeting provider agreement requirements.

·         Assist with oversight of the Provider Claim Dispute Resolution (PCDR) requirements for MCOs and OhioRISE.

·         Assisting with oversight of the MCO and OhioRISE provider representative requirement.

·         Researching and responding to managed care provider claim inquiries received directly by ODM.

·         Assisting with additional MCO, MyCare, and OhioRISE oversight as needed.

·         Participating in provider engagement activities that could include items such as attending meetings and seminars, preparing and delivering presentations, and reviewing provider training material.

·         Work collaboratively with internal and external stakeholders across various departments, levels, state agencies, and Managed Care Entities (MCEs) to improve provider engagement and the health care delivery system.

·         Work collaboratively with internal and external stakeholders across various departments, levels, state agencies, and Managed Care Entities (MCEs) to improve provider engagement, the health care delivery system and drive continuous improvement.

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:

• 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.

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 noted above may be substituted for the experience required, but not for the mandated licensure.

Job Skills: Health Administration

Supplemental Info:

The Ohio Department of Medicaid does not provide employment-based visa sponsorship.

Compensation is as listed on the posting unless required by legislation or union contract.

The work location of this position is 50 West Town Street, Columbus, Ohio 43215. You will be required to report to this work location full-time, if selected.

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.

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 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.