(Provider Compliance) Medicaid Health Systems Specialist

What You Will Do At ODM Office: Operations Bureau: Network Management Classification: Medicaid Health Systems Specialist (PN 20088910) Job Overview The Ohio Department of Medicaid is seeking a compliance professional to be a part of our Network Management team. As a provider of compliance team member your responsibilities will include: Knowledge of Federal and State policy to ensure Medicaid provider compliance. Sending out documentation and BCI requests for prospective providers; notify them of noncompliance when documentation is not receivedReviewing provider applications in their entirety, including but not limited to license limitations, BCI requirements, and additional supporting documents to meet enrollment requirements. Reviewing received BCIs and issue application denials for non-compliance and for applicants with disqualifying offenses Communicating regularly with the BCI office to check on missing BCIs Receiving work reports from State Sister Agency and complete actions as required on applications Frequently communicating (phone, email, etc.) with both providers and state sister agencies to resolve issues with applications to avoid provider abrasion and enrollment in a timely manner. 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 Agency Contact Name and Information HumanResources@medicaid.ohio.gov Unposting Date Sep 24, 2026, 11:59:00 PM Work Location Lazarus 4 Primary Location United States of America-OHIO-Franklin County-Columbus Compensation $36.01/hour Schedule Full-time Work Hours 8:00 am - 5:00 pm Classified Indicator Classified Union 1199 Professional Skills Analyzation, Interpreting Data, Responsiveness, Time Management, Confidentiality 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. Responsibilities 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.