Fraud Referral and Deconfliction Coordinator; Program Administrator

What You Will Do At ODM:

Working Title:

Fraud Referral and Deconfliction Coordinator

Office:
Legal Counsel

Bureau:
Program Integrity

Classification:
Program Administrator 2 (PN:)

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 years training or 4 years experience in business administration, management science or public administration
• Or completion of undergraduate core program in business administration, management science or public administration; 2 years training or 2 years experience in supervisory, administrative and/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 years training or 2 years experience in supervisory, administrative and/or managerial position or staff position involving planning, research and/or policy/procedure development
• Or 1 year experience as Program Administrator 1, 63122
• 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