Fraud Referral and Deconfliction Coordinator (Program Administrator 2)

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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