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 20045408)

Job Overview:

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 NexGen MyCare
• Acting as the point person for the NexGen MyCare program launching 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, Vue360, and/or Administrator).

At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:

• 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)

• Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.

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.

Job Skills: Health Administration

Technical Skills: Public Health, Data Analytics

Professional Skills: Collaboration, Analyzation, Interpreting Data, Attention to Detail

Compensation is as listed on the posting unless required by legislation or union contract.

This position is overtime exempt.

Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence.

Resumes and/or attachments are not reviewed. Therefore, please provide detail in the work experience section of your application.

Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.