(Provider Compliance) Medicaid Health Systems Specialist

Ohio Department of Medicaid; Columbus (OH); On-site; USD 43,000 - 56,000; Full time

Job summary

The Ohio Department of Medicaid is seeking a compliance professional to join our Network Management team as a Medicaid Health Systems Specialist. You will ensure provider compliance by reviewing applications, coordinating BCIs, and communicating with providers and state agencies to resolve enrollment issues.

Responsibilities include assessing documentation, issuing denials for non-compliance, and maintaining timely enrollment actions, with regular collaboration across departments.

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.
• 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.

Responsibilities

• 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.

Skills

Analyzation

Interpreting Data

Responsiveness

Time Management

Confidentiality

Health Administration

Education

Undergraduate core program

24 months experience or 24 months Medicaid Health Systems Analyst

Job description

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 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.

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

[e-mail]

Unposting Date

Sep 24, 2026, 10:59:00 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

• 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.