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). 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