(Provider Compliance) Medicaid Health Systems Specialist

State of Ohio; Columbus (OH); On-site; USD 47,000 - 52,000; Full time

Benefits offered by this job

Medical Coverage

Dental & Vision

Paid time off

11 paid holidays per year

Education and Development

Job summary

The Ohio Department of Medicaid is seeking a Medicaid Health Systems Specialist to join the Network Management team in Columbus. You will assess provider compliance, review applications and coordinate with the BCI office to ensure timely enrollments.

This full-time role requires knowledge of federal and state policy, strong data analysis, confidentiality, and excellent communication with providers and state partners.

Qualifications

• Undergraduate core program in business, social/behavioral science, health or statistics.
• 24 months of experience in the subject area; 12 months in use of spreadsheet and database software.

Responsibilities

• Ensure Medicaid provider compliance with federal and state policy.
• Review provider applications for licensing and BCIs; notify noncompliance when documentation is not received.
• Process enrollment requirements and issue denials for noncompliance.
• Coordinate with BCI office to track missing BCIs.
• Communicate with providers and state agencies to resolve enrollment issues in a timely manner.

Skills

Health Administration

Analyzation

Interpreting Data

Responsiveness

Time Management

Confidentiality

Education

Undergraduate degree in Business Administration, Health or Social/Behavioral Science

Job description

Job Description - (Provider Compliance) Medicaid Health Systems Specialist (260006TZ)

(Provider Compliance) Medicaid Health Systems Specialist ( 260006TZ )

Organization

Medicaid

Unposting Date

Sep 25, 2026, 3:59:00 AM

Work Location

Lazarus 4 50 West Town Street Columbus 43215

Primary Location

United States of America-OHIO-Franklin County-Columbus

Compensation : $36.01/hour

Schedule

Full-time

Union : 1199

Primary Job Skill

Health Administration

Technical Skills : Health Administration

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.

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 Description

What You Will Do at ODM:

Office: Operations

Bureau: Network Management

Classification: Medicaid Health Systems Specialist (PN20088910)

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 received


• Reviewing 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.

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 noted above may be substituted for the experience required, but not for the mandated licensure. Job Skills: Health Administration

Supplemental Information

Supplemental Info:

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.

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.