Fraud Referral and Deconfliction Coordinator (Program Administrator 2)

Ohio Department of Administrative Services • Columbus, OH

3d

About The Position

The Ohio Department of Medicaid (ODM), Office of Legal Counsel, is seeking an experienced healthcare program administrator to join the Program Integrity team. As Fraud Referral and Deconfliction Coordinator, your responsibilities will include, but not be limited to:
Processing provider fraud referrals, deconflictions and Managed Care Plan attestations in the fraud referral and coordination system
Coordinating program integrity activities across the bureau
Organizing and managing regular meetings with Managed Care Plan Special Investigations Units (SIU) and Managed Care Program Integrity Group (MCPIG)
Participating in key meetings related to provider fraud referrals, provider suspension, and provider termination
Tracking Managed Care Plan SIU and external stakeholders’ activities
Tracking and analyzing key program integrity performance metrics (e.g., fraud/abuse referrals) are being met by Managed Care Plans
Organizing and supporting Home Health Fraud work group
Providing oversight for contract vendors, deliverables, and contract costs
Performs other duties and administrative functions as assigned

Requirements

• 4 yrs. trg. or 4 yrs. exp. in business administration management science or public administration.
• Or completion of undergraduate core program in business administration, management science or public administration; 2 yrs. trg. or 2 yrs. exp. in supervisory, administrative &/or managerial position.
• Or completion of undergraduate core program in academic field commensurate with program area to be assigned per approved Position Description on file; 2 yrs. trg. or 2 yrs. exp. in supervisory, administrative &/or managerial position or staff position involving planning, research &/or policy/procedure development.
• Or 1 yr. exp. as Program Administrator 1, 63122.
• Or equivalent of Minimum Class Qualifications For Employment noted above
• Job Skills: Program Management
• Technical Skills: Program Management
• Professional Skills: Collaboration, Confidentiality, Continuous Improvement, Innovation, Verbal Communication, Written Communication, Organizing and Planning

Responsibilities

• Processing provider fraud referrals, deconflictions and Managed Care Plan attestations in the fraud referral and coordination system
• Coordinating program integrity activities across the bureau
• Organizing and managing regular meetings with Managed Care Plan Special Investigations Units (SIU) and Managed Care Program Integrity Group (MCPIG)
• Participating in key meetings related to provider fraud referrals, provider suspension, and provider termination
• Tracking Managed Care Plan SIU and external stakeholders’ activities
• Tracking and analyzing key program integrity performance metrics (e.g., fraud/abuse referrals) are being met by Managed Care Plans
• Organizing and supporting Home Health Fraud work group
• Providing oversight for contract vendors, deliverables, and contract costs
• Performs other duties and administrative functions as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed