Fraud Referral and Deconfliction Coordinator; Program Administrator

Overview

Job Description - Fraud Referral and Deconfliction Coordinator (Program Administrator
2) (2600018M)

Fraud Referral and Deconfliction Coordinator (Program Administrator
2) (2600018M)

Organization:
Medicaid

Unposting Date:
Mar 5, 2026, 10:59:00 PM

Work Location:

50 W Town St 50 West Town Street Suite 300 Columbus 43215

Primary

Location:

United States of America-OHIO-Franklin County-Columbus

Compensation: $32.35/hour

Schedule:

Full-time

Union:
Exempt from Union

Primary Job Skill:
Program Management

Technical

Skills:

Program Management

Professional

Skills:

Collaboration, Innovation, Organizing and Planning, Verbal Communication, Written Communication, Confidentiality, Continuous Improvement

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 a 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.

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

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…