What are the responsibilities and job description for the Claims Review Specialist - Intermittent - Two Positions (Medicaid Health Systems Specialist) position at Ohio Department of Medicaid?
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:
Technical Skills: Public Health
Professional Skills: Customer Focus, Analyzation, Attention to Detail, Collaboration
Organization
Medicaid
Agency Contact Name and Information
HumanResources@medicaid.ohio.gov
Unposting Date
Apr 20, 2025, 11:59:00 PM
Work Location
Lazarus 5
Primary Location
United States of America-OHIO-Franklin County-Columbus
Compensation
$33.45/hour
Schedule
Part-time
Work Hours
8:00 am - 5:00 pm
Classified Indicator
Unclassified
Union
1199
Primary Job Skill
Health Administration
Technical Skills
Public Health
Professional Skills
Analyzation, Attention to Detail, Collaboration, Customer Focus
Agency Overview
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.
Responsibilities
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:
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
- 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.
Technical Skills: Public Health
Professional Skills: Customer Focus, Analyzation, Attention to Detail, Collaboration
Organization
Medicaid
Agency Contact Name and Information
HumanResources@medicaid.ohio.gov
Unposting Date
Apr 20, 2025, 11:59:00 PM
Work Location
Lazarus 5
Primary Location
United States of America-OHIO-Franklin County-Columbus
Compensation
$33.45/hour
Schedule
Part-time
Work Hours
8:00 am - 5:00 pm
Classified Indicator
Unclassified
Union
1199
Primary Job Skill
Health Administration
Technical Skills
Public Health
Professional Skills
Analyzation, Attention to Detail, Collaboration, Customer Focus
Agency Overview
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.
Responsibilities
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.
Salary : $33
