Healthcare Compliance Reviewer (Medicaid Provider Oversight) - Ohio

Staffing Solutions Organization LLC (SSO), an affiliate of Public Consulting Group LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve.

Healthcare Compliance Reviewer (Medicaid Provider Oversight)

Field-based in Ohio - 3 Openings

Locations:

1 - Cincinnati/Dayton Area

1 - Cleveland Area

1 - Toledo Area

Employment Type: Full-Time

Pay Rate: $25.00 per hour

About the Role:

The Onsite 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.

Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides a reasonable range of compensation for this role. In addition, SSO provides a range of benefits for this role.

Applicants must be authorized to work in the U.S. This position is not eligible for work authorization sponsorship (including H-1B sponsorship) by SSO and under the federal laws relating to the F-1 STEM EAD program, this position is not eligible to support a STEM EAD extension application.  

All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an E-Verify participant.