Claims Review Specialist - Two Positions (Medicaid Health Systems Specialist)
- Medicaid
- Columbus, Ohio
- Full Time
Claims Review Specialist - Two Positions (Medicaid Health Systems Specialist) (250006FD)
Claims Review Specialist - Two Positions (Medicaid Health Systems Specialist)
(250006FD)
Organization: Medicaid
Agency Contact Name and Information: ...
Unposting Date: Aug 26, 2025, 9:59:00 PM
Work Location: Lazarus 5 50 West Town Street Columbus 43215
Primary Location: United States of America-OHIO-Franklin County
Compensation: $34.96/hour
Schedule: Full-time
Work Hours: 8:00 am - 5:00 pm
Classified Indicator: Classified
Union: 1199
Primary Job Skill: Health Administration
Technical Skills: Public Health
Professional Skills: Analyzation, Attention to Detail, Collaboration, Customer Focus
Agency Overview
About Us:
Investing in opportunities for Ohioans that work for every person and every family in every corner of our state is at the hallmark of Governor DeWine's agenda for Ohio's future. To ensure Ohio is the best place to live, work, raise and family and start a business, we must have strong schools, a great quality of life, and compassion for those who need our help.
Ohio Department of Medicaid plays a unique and necessary role in supporting the governor's vision. As the single state Medicaid agency responsible for administering high-quality, person-centric healthcare, the department is committed to supporting the health and wellbeing of nearly one in every four Ohioans served. We do so by:
Delivering a personalized care experience to more than three million people served.
Improving care for children and adults with complex behavioral health needs.
Working collectively with our partners and providers to measurably strengthen wellness and health outcomes.
Streamlining administrative burdens so doctors and healthcare providers have more time for patient care.
Ensuring financial transparency and operational accountability across all Medicaid programs and services.
Job Duties
What You Will Do at ODM:
Office: Data & Integrated Systems
Bureau: Infrastructure & Operations
Classification: Medicaid Health Systems Specialist (PN 20102504 & 20102505)
Job Overview:
The Ohio Department of Medicaid (ODM) is seeking healthcare professionals to be part of our Claims Resolution Outreach Team. As a Claims Review Specialist, your responsibilities will include:
reviewing and auditing medical claims submitted to ODM and processed by contractors
ensuring compliance with state reimbursement rules, desk-level procedures, and applicable federal and state policies
evaluating adherence to billing standards and identifies underpayments, overpayments, or processing discrepancies
assessing contractor performance against processing standards and contractual obligations
verifying claims compliance with applicable federal and state regulations (e.g. Medicaid, Medicare)
identifying patterns of non-compliance or systemic issues in claims handling
Why Work for the State of Ohio
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
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)
*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.
Qualifications
-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.
Job Skills: Health Administration
Technical Skills: Public Health
Professional Skills: Customer Focus, Analyzation, Attention to Detail, Collaboration
Claims Review Specialist - Two Positions (Medicaid Health Systems Specialist)
(250006FD)
Organization: Medicaid
Agency Contact Name and Information: ...
Unposting Date: Aug 26, 2025, 9:59:00 PM
Work Location: Lazarus 5 50 West Town Street Columbus 43215
Primary Location: United States of America-OHIO-Franklin County
Compensation: $34.96/hour
Schedule: Full-time
Work Hours: 8:00 am - 5:00 pm
Classified Indicator: Classified
Union: 1199
Primary Job Skill: Health Administration
Technical Skills: Public Health
Professional Skills: Analyzation, Attention to Detail, Collaboration, Customer Focus
Agency Overview
About Us:
Investing in opportunities for Ohioans that work for every person and every family in every corner of our state is at the hallmark of Governor DeWine's agenda for Ohio's future. To ensure Ohio is the best place to live, work, raise and family and start a business, we must have strong schools, a great quality of life, and compassion for those who need our help.
Ohio Department of Medicaid plays a unique and necessary role in supporting the governor's vision. As the single state Medicaid agency responsible for administering high-quality, person-centric healthcare, the department is committed to supporting the health and wellbeing of nearly one in every four Ohioans served. We do so by:
Delivering a personalized care experience to more than three million people served.
Improving care for children and adults with complex behavioral health needs.
Working collectively with our partners and providers to measurably strengthen wellness and health outcomes.
Streamlining administrative burdens so doctors and healthcare providers have more time for patient care.
Ensuring financial transparency and operational accountability across all Medicaid programs and services.
Job Duties
What You Will Do at ODM:
Office: Data & Integrated Systems
Bureau: Infrastructure & Operations
Classification: Medicaid Health Systems Specialist (PN 20102504 & 20102505)
Job Overview:
The Ohio Department of Medicaid (ODM) is seeking healthcare professionals to be part of our Claims Resolution Outreach Team. As a Claims Review Specialist, your responsibilities will include:
reviewing and auditing medical claims submitted to ODM and processed by contractors
ensuring compliance with state reimbursement rules, desk-level procedures, and applicable federal and state policies
evaluating adherence to billing standards and identifies underpayments, overpayments, or processing discrepancies
assessing contractor performance against processing standards and contractual obligations
verifying claims compliance with applicable federal and state regulations (e.g. Medicaid, Medicare)
identifying patterns of non-compliance or systemic issues in claims handling
Why Work for the State of Ohio
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
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)
*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.
Qualifications
-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.
Job Skills: Health Administration
Technical Skills: Public Health
Professional Skills: Customer Focus, Analyzation, Attention to Detail, Collaboration
Job ID: 490587109
Originally Posted on: 8/24/2025
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