Healthcare Compliance Reviewer (Medicaid Provider Oversight) - Ohio

Healthcare Compliance Reviewer (Medicaid Provider Oversight)
Field-based in Ohio - 3 Openings
Employment Type: Full-Time
Pay Rate: $25.00 per hour
About the Role:
The Healthcare Compliance Reviewer plays a critical role in ensuring Ohio Medicaid providers deliver legitimate services, maintain compliance with Ohio Administrative Code requirements, and operate from approved service locations. Using a comprehensive site review checklist approved by the Ohio Department of Medicaid (ODM), the Onsite Reviewer conducts independent, in-person provider assessments while collaborating with a larger quality assurance team.
This position requires extensive daily travel throughout Ohio, with occasional overnight stays based on assigned territories and schedules.
Key Responsibilities

Conduct onsite reviews of Ohio Medicaid provider locations throughout the state.
Travel daily to provider sites and complete assigned review schedules.
Execute ODM-approved site review checklists and conduct provider interviews in accordance with established protocols.
Assess provider operations, documentation practices, and regulatory compliance requirements.
Document site visit findings accurately, thoroughly, and professionally using proper grammar, punctuation, and objective observations.
Submit completed reviews within established quality assurance and compliance deadlines.
Analyze collected information and provide recommendations regarding provider enrollment or continued participation in Medicaid programs.
Maintain strict confidentiality regarding provider information, findings, and review outcomes.
Meet established productivity, quality, and customer service performance standards.
Work independently while effectively managing priorities, deadlines, and travel schedules.
Address provider questions and concerns professionally and identify opportunities for process improvement.
Utilize technology, tablets, and reporting systems to document and complete reviews.
Represent the organization professionally during all provider interactions.

Required Qualifications

Bachelor's Degree required.
Valid driver's license with an acceptable driving record.
Current automobile insurance.
Willingness and ability to travel extensively throughout Ohio.
Experience using tablets/iPads and Microsoft Office applications.
Strong written communication, documentation, and dictation skills.
Excellent organizational, time management, and analytical skills.
Demonstrated ability to work independently with minimal supervision.
Professional demeanor with strong interpersonal, listening, and communication skills.

Preferred Experience
Minimum of two (2) years of experience in one or more of the following areas:

Public Health
Critical Care
Home Health
Long-Term Care (LTC)
Behavioral Health or Mental Health Services
Developmental Disabilities Services
Children's Services
Elder Care Services
Community Social Services

In addition, experience in one or more of the following is preferred:

Medicaid programs
Provider monitoring or auditing
Compliance reviews
Third-party billing
Provider training and education
Healthcare operations
Quality assurance

What We're Looking For
Successful candidates will be:

Honest, dependable, and self-motivated.
Comfortable working independently in the field.
Detail-oriented with strong investigative and observational skills.
Skilled at analyzing information and making objective recommendations.
Able to maintain professionalism while navigating challenging situations.
Customer-focused with excellent problem-solving abilities.

Benefits Through Staffing Solutions Organization (SSO)
SSO offers a competitive benefits package that may include:

Medical Insurance
Dental Insurance
Vision Insurance
401(k) with Employer Match
Paid Time Off (PTO)
Paid Holidays
Flexible Spending Accounts (FSA)
Employee Assistance Program (EAP)
Additional Employee Perks

Keywords Search
Ohio Medicaid, Healthcare Compliance, Provider Review, Site Auditor, Healthcare Auditor, Field Reviewer, Quality Assurance, Medicaid Provider Enrollment, Regulatory Compliance, Home Health, Long-Term Care, Public Health, Behavioral Health, Provider Monitoring, Healthcare Operations, Field-Based Position, Statewide Travel, Documentation Review, Healthcare Inspection, Medicaid Compliance.