Encounter Data Liaison (Medicaid Health Systems Administrator 2)

State of Ohio • Columbus, OH

3d • Onsite

About The Position

The Ohio Department of Medicaid is seeking a healthcare professional to be part of our EDI & Encounters Team. This position serves as a technical and policy liaison for post-adjudication encounter data reporting submitted by managed care plans. Also, this position plays a critical role in ensuring data accuracy for rate setting, policy compliance, and quality care delivery. As the Encounter Data Liaison, your responsibilities will include: Developing policy, conducting program evaluation, and supporting data-driven decision-making. Serving as the primary liaison for encounter data reporting and quality assurance. Leading bi-weekly meetings with managed care organizations (MCOs) to discuss: Delivery kick payments Encounter data quality metrics Quality-based assignments New initiatives such as NexGen MyCare Acting as the point person for the NexGen MyCare program launched 1/1/2026, coordinating across multiple departments. Supporting rate setting, claims remittance investigations, and financial team collaboration. Interpreting and communicating data trends and anomalies to internal and external stakeholders.

Requirements

• Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 24 mos. exp. in planning & administering health services program or health services project management (e.g., health care data analysis, health services contract management, health care market & financial expertise; health services program communication; health services budget development, HMO & hospital rate development, health services eligibility, health services data analysis).
• 24 months experience as a Medicaid Health Systems Administrator 1, 65295.
• Equivalent of Minimum Class Qualifications for Employment noted above.
• Health Administration
• Public Health
• Data Analytics
• Collaboration
• Analyzation
• Interpreting Data
• Attention to Detail
• 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.

Nice To Haves

• Familiarity with X12 formats (e.g. 837, PACDR 837, 835, 999, 824, 277CA, 270).
• Proficiency in Medicaid data systems (i.e. MITS, Vue360, and/or Administrator).

Responsibilities

• Developing policy, conducting program evaluation, and supporting data-driven decision-making.
• Serving as the primary liaison for encounter data reporting and quality assurance.
• Leading bi-weekly meetings with managed care organizations (MCOs) to discuss delivery kick payments, encounter data quality metrics, quality-based assignments, and new initiatives such as NexGen MyCare.
• Acting as the point person for the NexGen MyCare program launched 1/1/2026, coordinating across multiple departments.
• Supporting rate setting, claims remittance investigations, and financial team collaboration.
• Interpreting and communicating data trends and anomalies to internal and external stakeholders.

Benefits

• 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 )

What This Job Offers

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