Edi Admin Jobs Near Me

What You Will Do at ODM:

Office: Data & Integrated Systems

Classification: Medicaid Health Systems Administrator 2 (PN 20102830)

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 launched 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