24 days old

Provider Enrollment Analyst (Medicaid Health Systems Analyst)

Columbus, OH 43215
  • Job Code


Office: Operations

Bureau: Network Management

Working title: Medicaid Heath Systems Analyst(PN 20088913)

Job Preview:

As the Provider Enrollment Analyst, you will conduct in depth research & analysis of health care & provider eligibility requirements. Also, you will need to be well versed in Ohio Administrative Code and Federal Guidelines surrounding Provider Enrollment and Provider Enrollment related rules to be able to function as a subject matter expert. Additionally, you will attend and participate in meetings.

Job Duties:

Under direction, monitors & evaluates Medicaid providers, projects, programs (e.g., may include components) or service delivery by participation on team to: conduct in depth research & analysis of health care & provider eligibility requirements (e.g., Home & Community Based Services (HCBS) waiver) to ensure program integrity to prevent Medicaid fraud during initial enrollment & screening process; researches electronic systems & databases (e.g., Centers for Medicare & Medicaid Services (CMS) Medicare eligibility system, Provider Enrollment & Chain Ownership System (PECOS), The Information Bus Company list server (CMS TIBCO)) for other states terminated providers, System for Award Management (SAM)); evaluates eligibility status as Medicaid provider; performs program & data analysis on enrollment policies & protocols for provider revalidation; evaluates site visit assessments to determine required actions (e.g., notice of deficiency & corrective action plans); interacts with State of Ohio sister agencies to accurately respond to provider questions & concerns regarding provider enrollments & revalidations; compiles & analyzes data reports on an ongoing basis; provides feedback & proposes changes/updates to policy sections.

Monitors & evaluates Ohio Department of Medicaid (ODM) enrollment program operations (e.g., screening protocols) to assure compliance with state & federal regulations: consults with ODM policy staff regarding program requirements; acts as liaison to internal Operations sections & various ODM bureaus on provider type & specialty eligibility criteria for revalidation & initial enrollment; implements screening protocols; interfaces with compliance unit; ensures unit staffs adherence to program integrity guidelines during initiation of provider agreements; assists lower level staff in responding to complex provider or applicant questions &/or application processing; processes initial &/or revalidation organizational applications as needed; assists in responding to inquiries (i.e., simple &/or complex) from existing providers & applicants seeking enrollment as Medicaid providers; assists with processing individual initial &/or revalidation applications; prepares reports & findings.

Performs other related duties as assigned (i.e., ancillary duties & functions based on job related tasks &/or program related needs): attends conferences, trainings, meetings, & workshops; represents department in administrative hearings (e.g., Ohio Administrative Code (OAC) Chapter 119 program appeal hearings); assists in coverage to cross-functional areas (e.g., covers absences, equalizes peak work periods &/or workloads); maintains logs, records, & files; attends & actively participates in special projects &/or focus groups.

Completion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 12 mos. exp. specific to subject area. Note: education & experience to be commensurate with approved position description on file.

-Or equivalent of Minimum Class Qualifications for Employment noted above.

Posted: 2021-03-26 Expires: 2021-04-24
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Provider Enrollment Analyst (Medicaid Health Systems Analyst)

Columbus, OH 43215

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