Provider Engagement Specialist (Medicaid Health Systems Specialist)

State of Ohio • Columbus, OH

7d • Onsite

About The Position

As a Provider Engagement Specialist on the Provider Relations team at the Ohio Department of Medicaid (ODM), your responsibilities will include reviewing and researching provider complaints submitted through HealthTrack, ensuring Managed Care Organizations (MCOs), MyCare, and OhioRISE meet provider agreement requirements, and assisting with oversight of Provider Claim Dispute Resolution (PCDR) requirements for MCOs and OhioRISE. You will also research and respond to managed care provider claim inquiries received directly by ODM, assist with additional MCO, MyCare, and OhioRISE oversight as needed, and participate in provider engagement activities such as attending meetings and seminars. This role involves collaborating with internal and external stakeholders across various departments, levels, state agencies, and Managed Care Entities (MCEs) to improve provider engagement, the health care delivery system, and drive continuous improvement.

Requirements

• 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.
• 24 months experience as Medicaid Health Systems Analyst, (65291)
• Equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.
• Health Administration

Responsibilities

• Review and research provider complaints that are submitted through HealthTrack in addition to ensuring Managed Care Organizations (MCOs), MyCare, and OhioRISE are meeting provider agreement requirements.
• Assist with oversight of the Provider Claim Dispute Resolution (PCDR) requirements for MCOs and OhioRISE.
• Researching and responding to managed care provider claim inquiries received directly by ODM.
• Assisting with additional MCO, MyCare, and OhioRISE oversight as needed.
• Participating in provider engagement activities that could include items such as attending meetings and seminars.
• Work collaboratively with internal and external stakeholders across various departments, levels, state agencies, and Managed Care Entities (MCEs) to improve provider engagement and the health care delivery system.
• Work collaboratively with internal and external stakeholders across various departments, levels, state agencies, and Managed Care Entities (MCEs) to improve provider engagement, the health care delivery system and drive continuous improvement.

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