HYBRID - Medicaid Quality Control Analyst (Case Management Analyst)

$60,798 - $60,798/Yr

State of Ohio - Columbus, OH

Full-time - Mid Level

Hybrid - Columbus, OH

Executive, Legislative, and Other General Government Support

About the position

The Ohio Department of Medicaid (ODM) is seeking a Medicaid Quality Control Analyst to join the Medicaid Eligibility Quality Control (MEQC) unit. This role is essential for ensuring the accuracy and timeliness of Medicaid eligibility determinations made by county departments. The analyst will conduct comprehensive reviews of cases, analyze compliance with federal and state regulations, and communicate findings to ODM leadership.

Responsibilities

• Conduct comprehensive case reviews of County Departments of Job and Family Services (CDJFS) and other participating agencies' records that determine eligibility for Medicaid programs.
• Review approval/denials of randomly selected CHIP and Medicaid cases to evaluate the accuracy of eligibility determinations.
• Analyze automated computer information systems to ensure county compliance with federal and state rules, regulations, and policies.
• Verify all aspects of Medicaid eligibility by reviewing case record information, electronic verifications, and eligibility system actions.
• Make final determinations at the conclusion of case review findings and provide results and analysis of reviews.
• Ensure compliance with federally mandated MEQC rules and regulations.
• Communicate with ODM leadership about issues identified during reviews.

Requirements

• Completion of undergraduate core coursework in social &/or behavioral science.
• 12 months training or 12 months experience in public assistance regulations & policies relative to all public assistance programs.
• 3 months training or 3 months experience in technical writing.
• 3 months training or 3 months experience in mainframe databases.
• Valid Ohio driver's license.
• Or 36 months experience as a public assistance caseworker, with experience in all categories of public assistance.

Nice-to-haves

• Background in Medicaid eligibility
• Strong analytical skills
• Attention to detail

Benefits

• 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)