Encounter Data Liaison (Medicaid Health Systems Administrator 2

What You Will Do At ODM

Office: Data & Integrated Systems

Classification: Medicaid Health Systems Administrator 2 (PN )

The Ohio Department of Medicaid is seeking a healthcare professional to be part of our EDI & Encounters Team. This position serves as a technical and policy liaison for post-adjudication encounter data reporting submitted by managed care plans. Also, this position plays a critical role in ensuring data accuracy for rate setting, policy compliance, and quality care delivery. As the Encounter Data Liaison, your responsibilities will include:

• Developing policy, conducting program evaluation, and supporting data-driven decision-making.
• Serving as the primary liaison for encounter data reporting and quality assurance.
• Leading bi-weekly meetings with managed care organizations (MCOs) to discuss:
• Delivery kick payments
• Encounter data quality metrics
• Quality-based assignments
• New initiatives such as Nex Gen My Care
• Acting as the point person for the Nex Gen MyCare program launched 1/1/2026, coordinating across multiple departments.
• Supporting rate setting, claims remittance investigations, and financial team collaboration.
• Interpreting and communicating data trends and anomalies to internal and external stakeholders.

The following qualifications are not required, but are preferred for success in this role:

• Familiarity with X12 formats (e.g. 837, PACDR 837, 835, 999, 824, 277CA, 270).
• Proficiency in Medicaid data systems (i.e. MITS, Vue
  360, and/or Administrator).

Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 24 mos. exp. in planning & administering health services program or health services project management (e.g., health care data analysis, health services contract management, health care market & financial expertise; health services program communication; health services budget development, HMO & hospital rate development, health services eligibility, health services data analysis).

• Or 24 months experience as a Medicaid Health Systems Administrator 1, 65295.
  
  Note:
  
  education & experience is to be commensurate with approved position description on file.
• Or equivalent of Minimum Class Qualifications for Employment noted above.

Health Administration

Public Health, Data Analytics

Collaboration, Analyzation, Interpreting Data, Attention to Detail

Work Location Lazarus 5

Primary Location United States of America-OHIO-Franklin County-Columbus

Compensation $44.38/hour

Schedule Full-time

Work Hours 8:00 am - 5:00 pm

Union Exempt from Union

Agency Overview

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.

• 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.