Fraud Referral and Deconfliction Coordinator - United States of America - OHIO - Franklin County - Columbus

What You Will Do At ODM: · Working Title\: Fraud Referral and Deconfliction Coordinator · Office\: Legal Counsel · Bureau\: Program Integrity · Classification\: Program Administrator 2 (PN\: · Job Overview: · The Ohio Department of Medicaid (ODM), Office of Legal Counsel, is see ...

Job description

What You Will Do At ODM:

Working Title\: Fraud Referral and Deconfliction Coordinator

Office\: Legal Counsel

Bureau\: Program Integrity

Classification\: Program Administrator 2 (PN\:

Job Overview:

The Ohio Department of Medicaid (ODM), Office of Legal Counsel, is seeking an experienced healthcare program administrator to join the Program Integrity team. As Fraud Referral and Deconfliction Coordinator, your responsibilities will include, but not be limited to:

• Processing provider fraud referrals, deconflictions and Managed Care Plan attestations in the fraud referral and coordination system
• Coordinating program integrity activities across the bureau
• Organizing and managing regular meetings with Managed Care Plan Special Investigations Units (SIU) and Managed Care Program Integrity Group (MCPIG)
• Participating in key meetings related to provider fraud referrals, provider suspension, and provider termination
• Tracking Managed Care Plan SIU and external stakeholders' activities
• Tracking and analyzing key program integrity performance metrics (e.g., fraud/abuse referrals) are being met by Managed Care Plans
• Organizing and supporting Home Health Fraud work group
• Providing oversight for contract vendors, deliverables, and contract costs
• Performs other duties and administrative functions as assigned

4 yrs. trg. or 4 yrs. exp. in business administration management science or public administration. 

-Or completion of undergraduate core program in business administration, management science or public administration; 2 yrs. trg. or 2 yrs. exp. in supervisory, administrative &/or managerial position. 

-Or completion of undergraduate core program in academic field commensurate with program area to be assigned per approved Position Description on file; 2 yrs. trg. or 2 yrs. exp. in supervisory, administrative &/or managerial position or staff position involving planning, research &/or policy/procedure development. 

-Or 1 yr. exp. as Program Administrator 1,

-Or equivalent of Minimum Class Qualifications For Employment noted above 

Job Skills: Program Management

Technical Skills\: Program Management

Professional Skills\: Collaboration, Confidentiality, Continuous Improvement, Innovation, Verbal Communication, Written Communication, Organizing and Planning

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.



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.

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.

Supplemental Information:

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

THIS POSITION IS UNCLASSIFIED PER A) (9), OHIO REVISED CODE.

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.

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.