Eligibility Compliance Specialist (Medicaid Health Systems Specialist)
About The Position
The Ohio Department of Medicaid is seeking an experienced professional to work in our Eligibility Compliance Unit. As a Medicaid Health Systems Specialist, your responsibilities will include: Monitor eligibility determinations and processes of County Departments of Job and Family Services (CDJFS) to ensure compliance with Medicaid rules Work with CDJFS to correct eligibility issues identified by business intelligence reporting and other Ohio Department of Medicaid work units Monitor reports to assist in the administration of Medicaid eligibility (application timeliness, renewal timeliness, and change processing) and assist in the creation of new monitoring reports Respond to inquiries from consumers, agency staff, stakeholders, and staff from other agencies Work closely with CDJFS to complete corrective action plans The preferred candidate will have experience determining Medicaid eligibility, monitoring compliance with Medicaid eligibility rules, troubleshooting Medicaid eligibility issues, and be proficient in Microsoft Excel. Completion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 24 months experience specific to subject area of which 12 months experience in use of spreadsheet and database software. 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. Note: education & experience to be commensurate with approved position description on file.
Requirements
- Completion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 24 months experience specific to subject area of which 12 months experience in use of spreadsheet and database software.
- 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.
Nice To Haves
- experience determining Medicaid eligibility
- monitoring compliance with Medicaid eligibility rules
- troubleshooting Medicaid eligibility issues
- proficient in Microsoft Excel
Responsibilities
- Monitor eligibility determinations and processes of County Departments of Job and Family Services (CDJFS) to ensure compliance with Medicaid rules
- Work with CDJFS to correct eligibility issues identified by business intelligence reporting and other Ohio Department of Medicaid work units
- Monitor reports to assist in the administration of Medicaid eligibility (application timeliness, renewal timeliness, and change processing) and assist in the creation of new monitoring reports
- Respond to inquiries from consumers, agency staff, stakeholders, and staff from other agencies
- Work closely with CDJFS to complete corrective action plans
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Industry
Executive, Legislative, and Other General Government Support
Number of Employees
5,001-10,000 employees
