(Provider Compliance) Medicaid Health Systems Specialist

Ohio Department of Administrative Services • Columbus, OH

2d

About The Position

The Ohio Department of Medicaid is seeking a compliance professional to be a part of our Network Management team. As a provider of compliance team member your responsibilities will include:
Knowledge of Federal and State policy to ensure Medicaid provider compliance.
Sending out documentation and BCI requests for prospective providers; notify them of noncompliance when documentation is not received
Reviewing provider applications in their entirety, including but not limited to license limitations, BCI requirements, and additional supporting documents to meet enrollment requirements.
Reviewing received BCIs and issue application denials for non-compliance and for applicants with disqualifying offenses
Communicating regularly with the BCI office to check on missing BCIs
Receiving work reports from State Sister Agency and complete actions as required on applications
Frequently communicating (phone, email, etc.) with both providers and state sister agencies to resolve issues with applications to avoid provider abrasion and enrollment in a timely manner.

Requirements

• Position requiring assessment or reassessment of clinical appropriateness of services &/or payment policies &/or related issues in regards to Medicaid health services delivery requires current & valid license as registered nurse as issued by Ohio Board of Nursing, pursuant to Sections 4723.03 & 4723.09 of Ohio revised code; additional 24 mos. exp. in nursing.
• Or for positions other than those requiring valid license as registered nurse, completion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 24 mos. exp. specific to subject area of which 12 mos. exp. in use of spreadsheet and database software.
• Note: education & experience to be commensurate with approved position description on file.
• Or for positions other than those requiring valid license as registered nurse, 24 months experience as Medicaid Health Systems Analyst, (65291) may be substituted for the experience required, but not for the mandated licensure.
• Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.
• Job Skills: Health Administration

Responsibilities

• Knowledge of Federal and State policy to ensure Medicaid provider compliance.
• Sending out documentation and BCI requests for prospective providers; notify them of noncompliance when documentation is not received
• Reviewing provider applications in their entirety, including but not limited to license limitations, BCI requirements, and additional supporting documents to meet enrollment requirements.
• Reviewing received BCIs and issue application denials for non-compliance and for applicants with disqualifying offenses
• Communicating regularly with the BCI office to check on missing BCIs
• Receiving work reports from State Sister Agency and complete actions as required on applications
• Frequently communicating (phone, email, etc.) with both providers and state sister agencies to resolve issues with applications to avoid provider abrasion and enrollment in a timely manner.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees