Medicaid Health Systems Specialist

State of Ohio Jobs    Columbus, OH
Job Description
Primary Location: United States of America-OHIO-Franklin CountyWork Locations: Lazarus 4 50 West Town Street Columbus 43215Organization: Ohio Department of MedicaidClassified Indicator: ClassifiedBargaining Unit / Exempt: Bargaining UnitSchedule: Full-timeWork Hours: 8:00am - 5:00pmCompensation: $27.55/hourUnposting Date: May 27, 2019, 10:59:00 PMJob Function: Health AdministrationAgency Contact Name: ODM Human ResourcesAgency Contact Information: [email protected]

Medicaid Health Systems Specialist

(190002Q6)Job DutiesUnless required by legislation or union contract, starting salary will be set at step 1 of the pay range.Office: Managed Care Bureau: Managed Care Compliance & OversightWorking Title: Provider Education Specialist (PN: 20046425)Job Preview:The Ohio Department of Medicaid (ODM) partners with over 83,000 active Medicaid Providers to ensure reliable and timely care is available for beneficiaries across the state. In order to maintain and continue this partnership, the Provider Education Specialist is needed to help build a strong network of providers that understand benefit resources and can effectively navigate Medicaid systems. In this position, the successful candidate will be able to effectively educate providers on ODM processes, prepare training materials, and deliver presentations. The successful candidate will also be proficient in the use of spreadsheet & database software, and will compile & analyze data & health care information from multiple sources.Position Description:Under general supervision, monitors & evaluates providers, projects, program of service delivery by participation on or leads a team to &/or work independently to conduct complex program analysis (e.g., compares/compiles federal & state regulations; implements policy decisions affecting delivery of service; compiles data & health care information from multiple sources; completes complex programmatic analysis to include one or more of following: resolves medical service delivery problems; reviews provider profiles for program issues & deficiencies; identifies area of required corrective action & asks for & reviews corrective action plan); on health care related issues (i.e., Medicaid dispute resolution process) using advanced computer software and complex computer systems (e.g., Management Information Technology Systems (MITS) & Microsoft Excel) initiates and completes complex, technical reports related to these issues; monitors provider usage & provides data to supervisor. Provides consultative expertise & training & acts as liaison to both intra-agency & inter-agency providers to deliver online focused training to our provider community; consults with Medicaid health care providers within the Provider Network Services regarding program development & evaluation; assists in resolving problems, planning corrective action plans & developing procedures to increase program effectiveness; interprets rules, policies & procedures regarding program requirements & delivery of health care systems; facilitates cooperative operation of Medicaid program with provider community & other departments; coordinates activities performed by other ODM units which are directly associated with administration &/or implementation of policies pertaining to provider network systems (e.g., assists ODM policy units by sharing results of monitoring & evaluation activities conducted by provider community); conducts &/or participates in provider conferences & workshops for ODM & other state & federal agencies; serves on committees & taskforces; prepares complex, technical reports, correspondences & memorandums (e.g., state & federal regulations, service delivery, standards of care & usage). Writes reports, position papers & research documents; operates personal computer to generate reports, correspondences &/or spreadsheets; researches information on mainframe &/or Internet; evaluates program effectiveness; writes monitoring & evaluation reports; designs & writes training packages; test system program enhancements; analyze, develop, review & revise provider handbooks; review & respond to clearance process comments; interpret rules & policies & communicate information to program staff, providers, other state agencies & consumers; responds to inquiries by providers & government officials by telephone, correspondence &/or in person. Performs other related duties (e.g., attends & participates in staff meetings; attends meetings & seminars; travels to meeting sites; coordinates & conducts public presentations; maintains program reference manuals; maintains records logs & files). QualificationsCompletion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 24 months of 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.
  • Knowledge of social or behavioral science or pre-medicine or comparable field; business administration; federal & state laws & regulations; agency policies & procedures; health care statistics, terminology & methods; public relations; public medical assistance programs; purchasing & payment practices of health care services; payment/pricing strategies; nursing. Skill in operating personal computer & applicable software applications (e.g., word processing; spreadsheet; databases). Ability to analyze multiple factors, apply factors & present findings & conclusions; read & comprehend clinical records; determine level of care; determine accuracy assessments & data; assess & monitor quality assurance & corrective action plans; prepare comprehensive & technical reports; interpret social welfare information & technical materials in books, journals & manuals; perform complex algebraic formulas; read & comprehend clinical records & residence &/or clinical data &/or quality assurance/corrective action plans to make appropriate assessments/referrals &/or to determine level of care & need; prepare review &/or evaluate records, reports, clinical assessments/data &/or financial/grant documents; handle routine & sensitive contacts with & inquiries from public, consumers, providers, & government officials in person, via telephone &/or through written correspondence. Supplemental Information:Attachments to your application are not accepted for this posting. Please be sure to provide detail in the job duty section of the application. All answers to supplemental questions must be supported by the work experience/education provided on your civil service application. Unless required by legislation or union contract, starting salary will be set at step 1 of the pay range.Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver s license from the state of residence. The final candidate selected for this position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant s prior criminal convictions will be made before excluding an applicant from consideration.

    Mon, 13 May 2019 19:01:44 GMT

    This job posting is no longer available on Jobrino.
    Find similar jobs: on Job Search
    All Jobs in Columbus, OH

    Recent from Blog

    The Jobrino blog is written with jobseeker and employers in mind to enable them to realize their full potential. Jobrino blog is your one-stop destination to find new research about the workplace and the latest insights into the employment market.

    5 Easy Steps to Start Branding Yourself as a Job Seeker

    Nowadays, in the job market, hiring managers and recruiters look for candidates who stand out from the crowd. They wish to know what makes you unique and what qualities you will bring to their company. Therefore, it is important you understand the relevance of ...

    Read more

    Top 10 Soft Skills for Job Seekers To Put On Resume [2018]

    In order to catch the eye of your recruiter it is important to not just have an impressive list of technical or hard skills but to have equally impressive interpersonal skills. Soft skills are today’s power skills. These skills are essential in ...

    Read more

    6 Coolest Entry Level Jobs To Apply For In 2018

    Time flies doesn’t it? We’re almost through a quarter of 2018! However, the minutes and hours only drag slowly when you’re in a job that doesn’t quite fit your dreams or your lifestyle. Quit wasting your energy in a job that doesn’t satisfy you or...

    Read more

    Here’s What to Wear to a Job Interview

    A job interview is one of the most stressful situations any of us are ever likely had experienced. But the old adage still stands: fail to prepare, prepare to fail. One may not control exactly how the meeting will go, or whether you get the job. But, as with most ...

    Read more