Eligibility Compliance Supervisor - PN 20097663 (Medicaid Health Systems Administrator 1)

State of Ohio; Columbus (OH); On-site; USD 46,000 - 65,000; Full time

Job summary

The Ohio Department of Medicaid is seeking an experienced Health Systems Administrator 1 to supervise the Eligibility Compliance Unit. You will oversee staff, ensure timely and accurate Medicaid determinations, and collaborate with county agencies to resolve eligibility issues.

Candidates should have graduate training in a relevant field and proficiency in Excel; travel may be required. You will report to the Bureau of Business Operational Support.

Qualifications

• Graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance.
• 12 months exp. in the delivery of a health services program or health services project management.
• Proficiency in Microsoft Excel and data analysis is preferred.

Responsibilities

• Supervise and direct the work activities of the Eligibility Compliance staff
• Oversee eligibility determinations and processes of County Departments of Job and Family Services to ensure compliance with Medicaid rules
• Collaborate with county agencies to correct eligibility issues identified by reporting
• Monitor key reports related to Medicaid eligibility administration and assist in creating new monitoring reports
• Coordinate and support eligibility audits conducted by state and federal partners
• Oversee responses to inquiries from consumers, agency staff, stakeholders, and partner agencies
• Collaborate with county agencies to develop and complete corrective action plans

Skills

Health Administration

Microsoft Excel

Education

Graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance

Current & valid license as registered nurse (RN) may be required depending on role

Job description

Posting Notice

All job postings will expire at 11:59 PM Eastern Time on the application deadline.

Organization Information

Organization: Medicaid

Agency Contact Name and Information: [e-mail]

Work Location: 50 West Town Street, Columbus, Ohio, 43215, United States

Compensation: $40.40/hour

Schedule: Permanent - Full Time

Work Hours: 8:00 am - 5:00 pm

Classified Indicator: Classified

Union: Exempt from union

Primary Job Skill: Health Administration

Who We Are

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.

What You'll Do

Office: Operations

Classification: Medicaid Health Systems Administrator 1 (PN 20097663)

Bureau: Business Operational Support

Job Overview: The Ohio Department of Medicaid is seeking an experienced professional to supervise our Eligibility Compliance Unit. As the Eligibility Compliance supervisor, you will supervise a team and manage work which will include:

• Supervise and direct the work activities of the Eligibility Compliance staff


• Oversee and monitor eligibility determinations and processes of County Departments of Job and Family Services (CDJFS) to ensure compliance with Medicaid rules.


• Collaborate with county agencies to correct eligibility issues identified by business intelligence reporting or other Ohio Department of Medicaid work units.


• Monitor key reports related to Medicaid eligibility administration (application timeliness, renewal timeliness, and change processing) and assist in the creation of new monitoring reports.


• Coordinate and support eligibility audits conducted by state and federal partners by guiding case review activities, liaising with county agencies to secure necessary case documentation, and providing training to auditors as necessary


• Oversee responses to inquiries from consumers, agency staff, stakeholders, and partner agencies, ensuring accurate and timely communication.


• Collaborate with county agencies to develop and complete corrective action plans.

The ideal candidate will have experience determining Medicaid eligibility, monitoring compliance with Medicaid eligibility regulations, troubleshooting complex eligibility issues, and demonstrating proficiency in Microsoft Excel.

Additional Information

The Ohio Department of Medicaid does not provide employment-based visa sponsorship.

Compensation is as listed on the posting unless required by legislation or union contract.

The work location of this position is 50 West Town Street, Columbus, Ohio 43215. You will be required to report to this work location full‑time, if selected.

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 state of residence.

Resumes and/or attachments are not reviewed. Therefore, please provide detail in the work experience section of your application.

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 graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance 12 mos. exp. in the delivery of a health services program or health services project management (e.g., health care data analysis, health services contract management, health care market & financial expertise health services program communication health services budget development, HMO & hospital rate development, health services eligibility, health services data base analysis).

-Or 12 months experience has Medicaid Health Systems Specialist, 65293, may be substituted for the experience required, but not for the mandated licensure, if required. Note: education & experience is to be commensurate with approved position description on file.

-If position oversees assessment or reassessment of clinical appropriateness of services &/or payment policies &/or related issues in regards to Medicaid health services delivery, incumbent must also have current & valid license as registered nurse as issued by Ohio Board of Nursing, pursuant to Sections 4723.03-4723.09 of Ohio Revised Code.

-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

ADA Statement

Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

Drug-Free Workplace

The State of Ohio is a drug‑free workplace which prohibits the use of marijuana (recreational marijuana/non‑medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.