Encounter Data Liaison (Medicaid Health Systems Administrator 2)

Job Overview: The Ohio Department of Medicaid is seeking a healthcare professional to join the EDI & Encounters Team as a technical and policy liaison for post-adjudication encounter data reporting submitted by managed care plans. This role ensures data accuracy for rate setting, policy compliance, and quality care delivery.

Responsibilities

• Develop policy, conduct program evaluation, and support data-driven decision-making.
• Serve as the primary liaison for encounter data reporting and quality assurance.
• Lead bi-weekly meetings with managed care organizations (MCOs) to discuss:
  • Delivery kick payments
  • Encounter data quality metrics
  • Quality-based assignments
  • New initiatives such as NexGen MyCare
• Act as the point person for the NexGen MyCare program (launched 1/1/2026), coordinating across multiple departments.
• Support rate setting, claims remittance investigations, and collaboration with the financial team.
• Interpret and communicate data trends and anomalies to internal and external stakeholders.

Qualifications

The following qualifications are preferred for success in this role:

• Familiarity with X12 formats (e.g., 837, PACDR 837, 835, 999, 824, 277CA, 270).
• Proficiency in Medicaid data systems (e.g., MITS, Vue360, and/or Administrator).
• Completion of a graduate core program in business, management, public administration, public health, health administration, social or behavioral science, or public finance; and 24 months of experience in planning and administering health services programs or health services project management (e.g., health care data analysis, health services contract management, health care market and financial expertise, health services program communication, health services budget development, HMO and hospital rate development, health services eligibility, health services data analysis).
• Or 24 months of experience as a Medicaid Health Systems Administrator 1, 65295.
• Or equivalent of the Minimum Class Qualifications for Employment noted above.

Skills

• Health Administration Technical Skills: Public Health, Data Analytics
• Professional Skills: Collaboration, Analyzation, Interpreting Data, Attention to Detail

Pay

$44.38/hour

Schedule

• Work Hours: 8:00 am – 5:00 pm
• Type: Full-time

About Us

The Ohio Department of Medicaid plays a unique and necessary role in supporting Governor DeWine’s vision for Ohio’s future. As the single state Medicaid agency, we are committed to supporting the health and wellbeing of nearly one in every four Ohioans 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 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.

Work Location: Lazarus 5, Columbus, OH (Franklin County)