Medicaid Health Systems Specialist

This role involves monitoring, evaluating, and supporting Medicaid-related projects and programs with a focus on populations served by Public Children's Services Agencies (PCSAs). Work is performed both independently and as part of cross functional teams. You will regularly collaborate with technical staff, policy experts, partner agencies, and stakeholders.

Key Activities You Can Expect in This Role

• Conduct complex statistical, financial, and program analyses, including reviewing and comparing federal and state regulations.
• Compile and interpret data from multiple health care and programmatic sources.
• Resolve issues related to medical service delivery and coverage for Medicaid recipients.
• Monitor managed care contracts to ensure compliance and develop performance based summaries.
• Use advanced databases and systems such as CCWIS, and Ohio Benefits to perform technical updates, process control file changes, and produce detailed reports.
• Provide consultative expertise, technical assistance, and training to internal and external stakeholders.
• Act as a liaison to agencies and divisions such as ODM, DODD, DYS, DCY's Policy team, and IT.
• Coordinate activities among entities responsible for implementing Medicaid policy related to PCSA involved youth.
• Participate in committees, task forces, conferences, and workshops, including projects like the Multi System Youth Grant initiative.
• Reconcile complex enrollment and disenrollment records and respond to inquiries from consumers, providers, CDJFS, PCSAs, officials, and contractors.
• Prepare position papers, research documents, monitoring reports, and evaluation summaries.
• Use computer systems and online resources to gather information and generate spreadsheets, correspondence, and reports.
• Assist with reviewing, drafting, and implementing Medicaid rules, especially those affecting youth under age 21.
• Collaborate with IT teams to ensure policy changes are accurately reflected in statewide systems.
• Compile and maintain Medicaid policy manual content.
• Support the promulgation of Ohio Administrative Code rules by analyzing legislation, reviewing policy alignment, and working with stakeholders.

Pay Information

Unless required by legislation or union contract, starting salary will be step 1 of the salary range associated with this position. New hires advance to the next step in the range after 6 months and annually thereafter. Based on collective bargaining and legislative activity, there may be cost of living increases awarded annually. Additional longevity supplements begin after 5 years. The current wage progression for this position is in the table below.

Months of Employment

At Hire

6 months

18 months

30 months

42 months

54 Months

66 Months

78 Months

Pay Range

1199/13

Step 1

Step 2

Step 3

Step 4

Step 5

Step 6

Step 7

Step 8

Hourly

$36.01

$37.75

$39.64

$41.53

$43.56

$45.72

$47.95

$50.37

Annual

$74,901

$78,520

$82,451

$86,382

$90,605

$95,098

$99,736

$104,770

Background Check Information

The final candidate selected for the 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.

Status of posted positions

You can check the status of your application online be signing into your profile and clicking the "My Jobpage" tab to view completed submissions and submission details. If you have questions other than your applications status, please direct them to DCY.HumanResources@childrenandyouth.ohio.gov.

Position requiring assessment or reassessment of clinical appropriateness of services &/or payment policies &/or related issues in regards to Medicaid health services delivery requires current & valid license as registered nurse as issued by Ohio Board of Nursing, pursuant to Sections 4723.03 & 4723.09 of Ohio revised code; additional 24 mos. exp. in nursing.

• Or for positions other than those requiring valid license as registered nurse, 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 for positions other than those requiring valid license as registered nurse, 24 months experience as Medicaid Health Systems Analyst, (65291) may be substituted for the experience required, but not for the mandated licensure.
• 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