What are the responsibilities and job description for the Claims Review Specialist - Intermittent - Two Positions (Medicaid Health Systems Specialist) position at State of Ohio Jobs?
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:
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
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.
Job Skills: Health Administration
Technical Skills: Public Health
Professional Skills: Customer Focus, Analyzation, Attention to Detail, Collaboration
Supplemental InformationTHIS POSITION IS UNCLASSIFIED PER 124.11 (A) (29), OHIO REVISED CODE.
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 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.
ADA StatementOhio 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.
Drug-Free WorkplaceThe 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.
