Healthcare Compliance Reviewer

Simple Staffing•Toledo, OH

2d•Onsite

About The Position

The Healthcare Compliance Reviewer conducts independent, in-person assessments of Ohio Medicaid provider locations to help ensure services are legitimate, providers comply with Ohio Administrative Code requirements, and services are delivered from approved locations. The reviewer uses a site review checklist approved by the Ohio Department of Medicaid (ODM) and collaborates with a quality assurance team. The role requires extensive daily travel throughout Ohio, with occasional overnight stays depending on territory and schedule. Reviewers assess provider operations, documentation, and regulatory compliance; document objective findings; submit reviews by established deadlines; and provide recommendations concerning provider enrollment or continued participation in Medicaid programs. The position also involves maintaining confidentiality, meeting productivity and quality standards, managing schedules independently, addressing provider questions professionally, and using technology and reporting systems to complete reviews.

Requirements

Bachelor's degree required.
Valid driver's license with an acceptable driving record.
Current automobile insurance.
Willingness and ability to travel extensively throughout Ohio.
Experience using tablets or iPads and Microsoft Office applications.
Strong written communication, documentation, and dictation skills.
Excellent organizational, time-management, and analytical skills.
Ability to work independently with minimal supervision.
Professional demeanor and strong interpersonal, listening, and communication skills.

Nice To Haves

At least two years of experience in one or more of these areas: public health, critical care, home health, long-term care, behavioral health or mental health services, developmental disabilities services, children's services, elder care services, or community social services.
Experience in one or more of these areas: Medicaid programs, provider monitoring or auditing, compliance reviews, third-party billing, provider training and education, healthcare operations, or quality assurance.
Honesty, dependability, and self-motivation.
Comfort working independently in the field.
Attention to detail and strong investigative and observational skills.
Ability to analyze information and make objective recommendations.
Ability to maintain professionalism in challenging situations.
Customer focus and strong problem-solving abilities.

Responsibilities

Conduct onsite reviews of Ohio Medicaid provider locations throughout the state.
Travel daily to provider sites and complete assigned review schedules.
Use ODM-approved site review checklists and conduct provider interviews according to established protocols.
Assess provider operations, documentation practices, and regulatory compliance requirements.
Document findings accurately, thoroughly, and professionally, using proper grammar, punctuation, and objective observations.
Submit completed reviews within quality assurance and compliance deadlines.
Analyze collected information and recommend whether providers should enroll in or continue participating in Medicaid programs.
Maintain strict confidentiality regarding provider information, findings, and review outcomes.
Meet established productivity, quality, and customer service performance standards.
Work independently while managing priorities, deadlines, and travel schedules.
Address provider questions and concerns professionally and identify opportunities for process improvement.
Use tablets, technology, and reporting systems to document and complete reviews.
Represent the organization professionally during provider interactions.