Electronic Visit Verification Program Specialist (Medicaid Health Systems Specialist) at STATE OF OHIO in Columbus, Ohio

Job Description:

Unless required by legislation or union contract, starting salary will be set at step 1 of the pay range.

Office: Legal Counsel

Bureau: Program Integrity Compliance

Job Preview: 

In this position, you will be responsible for using professional customer service and critical thinking skills while responding to Electronic Visit Verification (EVV) inquiries that come into the EVV inbox. Additionally, you will be responsible for taking on a leadership role to facilitate meetings and coordinate EVV activities. This position will have the opportunity to hone in on data analytics skills to review data in determining if any anomalies exist. It is expected the candidate for this role has good report writing skills and ability to communicate effectively. This position may also complete referrals to investigative agencies for civil or criminal reviews. The successful candidate may also be asked to assist with oversight of the EVV contract. This position may require outreach and training to Medicaid Providers and individuals receiving services, and as well as Government Agencies.

Position Description:

Under general supervision, monitors & evaluates providers, projects, program (e.g., may include components) or service delivery by participation on or leads a team to &/or works independently to: Conduct complex analysis (i.e., conducts data analysis to identify anomalies in provider activities; preforms in-depth reviews & analysis of records & operations) on Medicaid's Electronic Visit Verification (EVV) system using advanced statistical techniques; monitors and evaluates providers making EVV home health visits; provides support to provider enrollment to identify areas on non-compliance; using available data, identifies & evaluates areas of needed improvement regarding EVV home health care services; determines areas of outreach (e.g., telephone &/or in person) to improve EVV reporting by providers (e.g., reviews EVV bypass functionality for abuse &/or training needs; monitors EVV activity prior to system launch to provide provider support); compiles data & information regarding home health care visits from multiple sources (e.g., Medicaid Information Technology Systems (MITS), eligibility systems, Quality Decision Support System/QDSS); initiates/completes technical reports; collaborates with Surveillance Utilization & Review Section (SURS) to identify data mining needs & provides necessary information to SURS for case creation & referral to Medicaid Fraud Control Unit (MFCU) &/or other appropriate governmental agencies.

Provides consultative expertise & training on EVV System & other home health visit service issues; acts as liaison to both intra-agency & inter-agency providers regarding EVV home health care services; conducts outreach to individuals receiving EVV home health services to identify areas of fraud; provides technical assistance to agencies & providers (e.g., offers advice on how to improve internal controls & implementing corrective actions; researches federal & state laws, rules, regulations to assist administrators in developing administrative rules, policies & procedures impacting EVV functions &/or fiscal test functions); acts as quality control technician (e.g., performs internal testing of EVV data); participates in user acceptance testing for both new and existing systems; participates in any system or program related business requirement meetings; identifies and documents areas of improvement within EVV system; represents the unit at conferences, meetings & workshops; serves on committees & task forces; prepares complex technical reports, correspondence & memorandums; responds to inquiries by consumers, providers, county agencies & government officials by telephone, computer, correspondence &.or in person; prepares internal & external EVV presentations; leads internal agency meetings related to EVV outreach and other reoccurring meetings; facilitates the EVV Newsletter with vendor and internal policy personnel; works on the EVV mailbox responding to inquiries and pulling in appropriate individuals when needed; documents formal summary and recommendations of EVV related issues or concerns and presents to management for next steps and approval; assists in coordinating and scheduling meetings as needed; assists In monitoring vendor compliance with contract service level requirements.

Writes reports, position papers & researches documents; monitors health reports (e.g., MITS and EVV interaction, EVV down time, EVV mobile device vendor compliance); operates a personal computer to generate reports, correspondence &/or spreadsheets; researches information within claims system and internet; gathers collates & summarizes statistical, demographic & anecdotal information for EVV home health services; evaluates program effectiveness; writes monitoring & evaluation reports; designs & writes training; acts as backup to other specialists within the unit (e.g., workload, vacation, special projects).

Performs other related duties as assigned (e.g., attends & participates in staff meetings; attends meetings & trainings; travels to meeting & training sites; maintains logs, records & files).

For positions other than those requiring valid license as registered nurse, completion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 24 mos. exp. specific to subject area of which 12 mos. exp. in use of spreadsheet and database software.

Note: education & experience to be commensurate with approved position description on file.