Ohio
Fraud Referral and Deconfliction Coordinator (Program Administrator 2)
Ohio, Columbus, Ohio, United States, 43224
What You Will Do At ODM
Working Title: Fraud Referral and Deconfliction Coordinator
Office: Legal Counsel
Bureau: Program Integrity
Classification: Program Administrator 2 (PN:20036504)
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
Qualifications
4 yrs. trg. or 4 yrs. exp. in business administration management science or public administration.
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.
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.
1 yr. exp. as Program Administrator 1, 63122.
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
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Office: Legal Counsel
Bureau: Program Integrity
Classification: Program Administrator 2 (PN:20036504)
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
Qualifications
4 yrs. trg. or 4 yrs. exp. in business administration management science or public administration.
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.
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.
1 yr. exp. as Program Administrator 1, 63122.
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
#J-18808-Ljbffr