Eligibility Compliance Supervisor - PN 20097663 (Medicaid Health Systems Administrator 1)

State of Ohio • Columbus, OH

6d • Onsite

About The Position

The Ohio Department of Medicaid is seeking an experienced professional to supervise its Eligibility Compliance Unit within the Bureau of Business Operational Support. The supervisor leads staff and oversees county eligibility determinations and processes to ensure compliance with Medicaid rules. The role also monitors eligibility performance, helps resolve issues with county agencies, supports state and federal audits, oversees responses to inquiries, and coordinates corrective action plans.

This position is based at 50 West Town Street in Columbus, Ohio, and requires full-time reporting to that location. Travel is required as needed, and the employee must provide their own transportation or have a valid driver's license from their state of residence to operate a state vehicle. The position does not provide employment-based visa sponsorship.

Requirements

• Completion of a graduate core program in business, management, public administration, public health, health administration, social or behavioral science, or public finance.
• Twelve months of experience delivering a health services program or in health services project management, such as health care data analysis, health services contract management, health care market and financial expertise, health services program communication, health services budget development, HMO and hospital rate development, health services eligibility, or health services database analysis.
• Twelve months of experience as a Medicaid Health Systems Specialist may substitute for the required experience, but not for any mandated licensure.
• The equivalent of the minimum class qualifications may substitute for the required experience, but not for any mandated licensure.
• If the position oversees assessment or reassessment of clinical appropriateness of services, payment policies, or related Medicaid health services delivery issues, a current, valid Ohio registered nurse license is required.
• The ideal candidate has experience determining Medicaid eligibility, monitoring compliance with Medicaid eligibility regulations, and troubleshooting complex eligibility issues.
• Must demonstrate proficiency in Microsoft Excel.
• Must provide own transportation, or have a valid driver's license from their state of residence to operate a state vehicle.

Nice To Haves

• Experience determining Medicaid eligibility.
• Experience monitoring compliance with Medicaid eligibility regulations.
• Experience troubleshooting complex eligibility issues.
• Proficiency in Microsoft Excel.

Responsibilities

• Supervise and direct the work activities of Eligibility Compliance staff.
• Oversee and monitor County Departments of Job and Family Services eligibility determinations and processes to ensure compliance with Medicaid rules.
• Collaborate with county agencies to correct eligibility issues identified through business intelligence reporting or by other Ohio Department of Medicaid work units.
• Monitor reports related to Medicaid eligibility administration, including application timeliness, renewal timeliness, and change processing.
• Assist in creating new eligibility monitoring reports.
• Coordinate and support eligibility audits conducted by state and federal partners, including guiding case review activities, obtaining case documentation from county agencies, and providing training to auditors as needed.
• Oversee responses to inquiries from consumers, agency staff, stakeholders, and partner agencies, ensuring accurate and timely communication.
• Collaborate with county agencies to develop and complete corrective action plans.

Benefits

• Medical coverage.
• Dental, vision, and basic life insurance premiums provided at no cost after completion of the eligibility period.
• Paid time off, including vacation, personal and sick leave, and 11 paid holidays per year.
• Childbirth, adoption, and foster care leave.
• Education and development opportunities, including Employee Development Funds and Public Service Loan Forgiveness.
• Public retirement systems, including OPERS, STRS, SERS, and HPRS, and optional deferred compensation.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager