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Managed Care Reconciliation Specialist (Medicaid Health Systems Specialist) at STATE OF OHIO

Posted in Management 30+ days ago.

Type: Full-Time
Location: Columbus, Ohio





Job Description:


The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. In 2020, ODM introduced a new vision for Ohio’s Medicaid program -- one that strengthens Ohio’s future and ensures everyone has the chance to live life to its full potential.

Today, more than 90 percent of Ohio Medicaid members are supported by managed care organizations. During the year ahead, ODM will begin implementing a new vision for care; focusing on the individual, a strong partnership among MCOs and the department, and supporting specialization in addressing critical needs.

A program that puts the individual first

Adopting Governor DeWine’s philosophy of service to Ohioans, ODM embarked on an aggressive effort to redesign its managed care program. The goal is to provide more personal, holistic care and supports for millions of Ohioans served by Medicaid. Listening to feedback from more than 1,100 individuals and organizations we identified five procurement goals that would put the individual front and center of Medicaid’s program and policy decisions. They are:


  • Emphasize a personalized care experience,

  • Improve care for children and adults with complex behavioral health needs,

  • Improve wellness and health outcomes,

  • Support providers in better patient care and

  • Increase program transparency and accountability.

Unless required by legislation or union contract, starting salary will be set at step 1 of the pay range.

 

Office: Managed Care

BureauMember Services

Classification: Medicaid Health Systems Specialist (PN:20047457

)

 

Job Overview:

As the Managed Care Reconciliation Specialist in the Office of Managed Care, Ohio Department of Medicaid (ODM), your responsibilities will include:


  • Monitoring and evaluating program policies and procedures to assure compliance with federal and state regulations

  • Creating and running reports to identify managed care enrollment discrepancies

  • Reviewing and analyzing managed care enrollment

  • Collaborating with both state staff and stakeholders to ensure proper managed care enrollment

  • Correcting enrollment spans using both manual and mass upload processes

  • Responding to inquiries by consumers, providers, county agencies, MCP & government officials by telephone, written correspondence or in person

  • Summarizing findings and recommendations for change on health care related issues using complex computer systems

Completion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 24 months experience specific to subject area of which 12 months experience in use of spreadsheet and database software.


-Or 24 months experience as Medicaid Health Systems Analyst, (65291). 


-Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required.

Note: education & experience to be commensurate with approved position description on file.





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