Eligibility Compliance Specialist (Medicaid Health Systems Specialist)

What You Will Do At ODM

Office: Operations

Bureau: Business Operational Support

Classification: Medicaid Health Systems Specialist (PN 20037632)

Job Overview

The Ohio Department of Medicaid is seeking an experienced professional to work in our Eligibility Compliance Unit. As a Medicaid Health Systems Specialist, your responsibilities will include:

• Monitor eligibility determinations and processes of County Departments of Job and Family Services (CDJFS) to ensure compliance with Medicaid rules
• Work with CDJFS to correct eligibility issues identified by business intelligence reporting and other Ohio Department of Medicaid work units
• Monitor reports to assist in the administration of Medicaid eligibility (application timeliness, renewal timeliness, and change processing) and assist in the creation of new monitoring reports
• Respond to inquiries from consumers, agency staff, stakeholders, and staff from other agencies
• Work closely with CDJFS to complete corrective action plans
  
  

The preferred candidate will have experience determining Medicaid eligibility, monitoring compliance with Medicaid eligibility rules, troubleshooting Medicaid eligibility issues, and be proficient in Microsoft Excel.

Completion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 24 months experience specific to subject area of which 12 months experience 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.
  
  

Note: education & experience to be commensurate with approved position description on file.

Job Skills: Health Administration

Organization

Medicaid

Agency Contact Name and Information

HumanResources@medicaid.ohio.gov

Unposting Date

Dec 1, 2025, 4:59:00 AM

Work Location

Lazarus 4

Primary Location

United States of America-OHIO-Franklin County-Columbus

Compensation

$34.96/hour

Schedule

Full-time

Work Hours

8:00 am - 5:00 pm

Classified Indicator

Classified

Union

1199

Primary Job Skill

Health Administration

Technical Skills

Health Administration

Professional Skills

Collaboration, Consultation, Verbal Communication, Written Communication

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

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.