Healthcare Compliance Reviewer; Medicaid Provider Oversight; Ohio

Locations:

1 - Akron/Canton/Youngstown area

1 - Columbus

1 - Toledo area

Employment Type:

Full-Time

Pay Rate: $25.00 per hour

The Onsite Reviewer plays a critical role in ensuring Ohio Medicaid providers deliver legitimate services, maintain compliance with Ohio Administrative Code requirements, and operate from approved service locations. Using a comprehensive site review checklist approved by the Ohio Department of Medicaid (ODM), the Onsite Reviewer conducts independent, in-person provider assessments while collaborating with a larger quality assurance team.

This position requires extensive daily travel throughout Ohio, with occasional overnight stays based on assigned territories and schedules.

• Conduct onsite reviews of Ohio Medicaid provider locations throughout the state.
• Travel daily to provider sites and complete assigned review schedules.
• Execute ODM-approved site review checklists and conduct provider interviews in accordance with established protocols.
• Assess provider operations, documentation practices, and regulatory compliance requirements.
• Document site visit findings accurately, thoroughly, and professionally using proper grammar, punctuation, and objective observations.
• Submit completed reviews within established quality assurance and compliance deadlines.
• Analyze collected information and provide recommendations regarding provider enrollment or continued participation in Medicaid programs.
• Maintain strict confidentiality regarding provider information, findings, and review outcomes.
• Meet established productivity, quality, and customer service performance standards.
• Work independently while effectively managing priorities, deadlines, and travel schedules.
• Address provider questions and concerns professionally and identify opportunities for process improvement.
• Utilize technology, tablets, and reporting systems to document and complete reviews.
• Represent the organization professionally during all provider interactions.

• Bachelor's Degree required.
• Valid driver's license with an acceptable driving record.
• Current automobile insurance.
• Willingness and ability to travel extensively throughout Ohio.
• Experience using tablets/iPads and Microsoft Office applications.
• Strong written communication, documentation, and dictation skills.
• Excellent organizational, time management, and analytical skills.
• Demonstrated ability to work independently with minimal supervision.
• Professional demeanor with strong interpersonal, listening, and communication skills.

Minimum of two (2) years of experience in one or more of the following areas:

• Public Health
• Critical Care
• Home Health
• Long-Term Care (LTC)
• Behavioral Health or Mental Health Services
• Developmental Disabilities Services
• Children's Services
• Elder Care Services
• Community Social Services

In addition, experience in one or more of the following is preferred:

• Medicaid programs
• Provider monitoring or auditing
• Compliance reviews
• Third-party billing
• Provider training and education
• Healthcare operations
• Quality assurance

• Honest, dependable, and self-motivated.
• Comfortable working independently in the field.
• Detail-oriented with strong investigative and observational skills.
• Skilled at analyzing information and making objective recommendations.
• Able to maintain professionalism while navigating challenging situations.
• Customer-focused with excellent problem-solving abilities.

• Medical Insurance
• Dental Insurance
• Vision Insurance
• 401(k) with Employer Match
• Paid Time Off (PTO)
• Paid Holidays
• Flexible Spending Accounts (FSA)
• Employee Assistance Program (EAP)
• Additional Employee Perks

Ohio Medicaid, Healthcare Compliance, Provider Review, Site Auditor, Healthcare Auditor, Field Reviewer, Quality Assurance, Medicaid Provider Enrollment, Regulatory Compliance, Home Health, Long-Term Care, Public Health, Behavioral Health, Provider Monitoring, Healthcare Operations, Field-Based Position, Statewide Travel, Documentation Review, Healthcare Inspection, Medicaid Compliance.