Provider Engagement Specialist (Medicaid Health Systems Specialist)

What You Will Do At ODM

Office: Operations

Bureau: Network Management

Classification: Medicaid Health Systems Specialist (PN 20046417)

Job Overview

As a Provider Engagement Specialist on the Provider Relations team at the Ohio Department of Medicaid (ODM), your responsibilities will include:

• Review and research provider complaints that are submitted through HealthTrack in addition to ensuring Managed Care Organizations (MCOs), MyCare, and OhioRISE are meeting provider agreement requirements.
• Assist with oversight of the Provider Claim Dispute Resolution (PCDR) requirements for MCOs and OhioRISE.
• Researching and responding to managed care provider claim inquiries received directly by ODM.
• Assisting with additional MCO, MyCare, and OhioRISE oversight as needed.
• Participating in provider engagement activities that could include items such as attending meetings and seminars.
• Work collaboratively with internal and external stakeholders across various departments, levels, state agencies, and Managed Care Entities (MCEs) to improve provider engagement and the health care delivery system.
• Work collaboratively with internal and external stakeholders across various departments, levels, state agencies, and Managed Care Entities (MCEs) to improve provider engagement, the health care delivery system and drive continuous improvement.
  
  

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

HumanResources@medicaid.ohio.gov

Unposting Date

Jun 4, 2026, 11:59:00 PM

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

Professional Skills

Analyzation, Collaboration, Interpreting Data, 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.