This position will be telework eligible on a hybrid basis.
About Us:
The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. ODM is implementing the next generation of Ohio Medicaid to fulfill its bold, new vision for Ohio’s Medicaid program – focusing on the individual rather than the business of managed care.
The goals of the next generation of Ohio Medicaid 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
What You Will Do at ODM:
Working Title: Provider Engagement Specialist
Office: Operations
Bureau: Business Operational Support, Provider Relations
Classification: Medicaid Health Systems Specialist (PN 20046423)
As a Provider Engagement Specialist on the Provider Relations team at the Ohio Department of Medicaid (ODM), your responsibilities will include:
- Review and research non-institutional provider complaints submitted through HealthTrack; ensure Managed Care Organizations (MCOs), MyCare, and OhioRISE meet provider agreement requirements
- Participate in oversight of the Provider Claim Dispute Resolution process for MCOs and OhioRISE
- Participate in Provider Advisory Council (PAC) meetings and review PAC reports
- Research and respond to managed care provider claim inquiries received directly by ODM
- Research and resolve escalated fee-for-service (FFS) non-institutional provider claim inquiries
- Conduct non-institutional FFS provider consultations as needed
- Attend meetings, seminars, prepare & deliver presentations, review provider training material
- 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
What’s in it for you:
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. For a list of all the State of Ohio Benefits, visit our Total Rewards website ! Our benefits package includes:
Medical Coverage
- Quality, affordable, and competitive medical benefits are offered through the Ohio Med PPO plan.
Dental, Vision and Basic Life Insurance
- Dental, vision and basic life insurance premiums are free after one year of continuous service.
Time Away From Work and Work/Life Balance
- Paid time off, including vacation, personal, and sick leave
- 11 paid holidays per year
- Childbirth/Adoption leave
Ohio Public Employees Retirement System
- OPERS is the retirement system for State of Ohio employees. The employee contributes 10% of their salary towards their retirement. The employer contributes an amount equal to 14% of the employee’s salary. Visit the OPERS website for more information.
Deferred Compensation
- The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.
Qualifications
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.