Provider Engagement Specialist (Medicaid Health Systems Specialist)

What You Will Do at ODM:

Office: Operations

Bureau: Network Management

Classification: Medicaid Health Systems Specialist (PN 20046417)

Job Overview:

As a Provider Engagement Specialist on the Provider Relations team at the Ohio Department of Medicaid (ODM), your responsibilities will include:

• 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.

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 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, but not for the mandated licensure.

Job Skills: Health Administration