Under the supervision of the Special Education Director, the Medicaid Specialist manages the Medicaid claim program for special education services. Incumbent will coordinate a high volume of data including student claims, parent consent, and provider information. Will provide training to providers and monitor participation in required Medicaid procedures. Serves as the primary point of contact for all Medicaid program activities.

• Responsible for knowing all compliance requirement for Medicaid in the Public Schools;
• Develops, maintains, manages and balances the Medicaid billing reimbursement program for all SPED programs; Develops procedures for Medicaid documentation and reimbursement and ensures compliance;
• Monitors Medicaid billing data and systems for both direct and administrative claims; Submits and monitors all aspects of Medical billing, re-billing, and payments in accordance with Medicaid policies and procedures;
• Reconciles accounts and researches billing discrepancies; Ensures accuracy and follows through on payments received in error;
• Coordinates all billable services (i.e. skilled nursing, psychological, speech, physical and occupational therapy, etc.); Creates, maintains and provides supporting documentation and provider qualifications;
• Monitors and maintains payment systems in order to obtain maximum revenue;
• Audits reports for accuracy Personal Care/Direct Service logs;
• Trains district personnel in Medicaid requirements, procedures, and compliance, including Medicaid eligibility lists, consent forms, billing session notes, etc.;
• Oversees and administers Medicaid compliance programs such as time study, narrative logs, and coding issues;
• Coordinates and schedules time studies on schedule, every three years; Sends reminders of time study requirements, ensures coding is accurate and resets passwords as needed; Generates report of staff participation, completion, and reimbursements; Adheres to regulations and policies while tracking employees through time study to ensure 100% completion;
• Maintains documentation, per state or federal requirements, showing all staff has attended required training sessions;
• Creates procedure manuals, documentation, checklists, or guidelines as necessary; Updates training materials as needed;
• Ensures all staff maintains required current provider registration status;
• Researches Related Servers certification through websites of sanctioned providers to determine any licensure concerns on a monthly basis;
• Prepares quarterly reports and present information to Special Education Director;
• Provides Medicaid billing and audit reports for local, state, and federal audits;
• Compiles operational statistics and gathers data that may be required for federal or state reporting;
• Reviews data regularly for accuracy and compliance;
• Answers questions, provide forms, process documentation, expedite and resolve problems;
• Works closely with parents to obtain parental consent forms online or via US mail; Works with case managers for completion of forms;
• Prepares, maintains and reviews all student Medicaid files; Ensures files meet requirements for annual audits or review;
• Analyzes documentation in case files for quality, accuracy, follow-up or changes in status;
• Maintains confidentiality of student records and personal information;
• Stays abreast of changes and developments in the Medicaid reimbursement program and attends Medicaid meetings or continuing education sessions conducted by state or federal agencies;
• Coordinates with other school districts or outside agencies to resolve problems or situations for Medicaid in school reimbursement;
• Interfaces with federal, state, local, and private agencies to obtain information about eligible students;
• Creates and delivers required surveys, data, reports, or program information requested by state or federal departments and agencies;
• Acts as District liaison with appropriate government agencies;
• May provide some secretarial, clerical, or receptionist duties to the department; Duties typically include answering phones, providing information concerning department or program; word processing/typing; maintaining records and files; monitoring budgets, preparing reports; scheduling appointments; and assisting with coordination of events or activities;
• Manages the local Medicaid revenue and operational budget;
• Performs other duties as assigned by the Director of Special Education/student Services.

Knowledge of district policies, state and federal laws and regulations related to Medicaid program administration in education. Ability to read, write and perform basic mathematical calculations. Ability to operate a computer, peripherals, and application software programs including database management, spreadsheets, word processing and other proprietary software related to assignment. Demonstrated ability to use and manipulate data in Microsoft Excel or other spreadsheet program. Technical knowledge of state and local Medicaid procedures, processes and terminology. Knowledge of school district procedures, policies, rules and processes. Knowledge of applicable laws, rules, policies, and procedures as they relate to Federal and State Medicaid laws. Capable of making decisions acknowledging established procedures and practices. Medicaid billing data entry experience for a public school district is highly desirable. Ability to deal with confidential and sensitive matters in a professional manner. Strong English written and verbal communication skills. Ability to interpret, apply, and explain applicable district policies and procedures. Strong interpersonal skills for dealing with public and other office staff. Ability to accept, receive or collect payment. Ability to manage budget. Promotes cultural understanding and competency and an organizational climate of equity and inclusion

Any combination of education and experience equivalent to graduation from an accredited four-year college or university with major work in human services, business, or related field. Three to five years of experience of a responsible nature in the area assigned, including some supervisory experience. Considerable experience using personal computer and mainframe applications.

The physical requirements described herein are representative of those which must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities, who are otherwise qualified, to perform the essential functions. Must have the ability to sit and stand for extended periods of time; exhibit manual dexterity to dial a telephone, to enter data into a computer terminal; to see and read a computer screen and printed material with or without vision aids; hear and understand speech at normal office levels and on the telephone; speak in audible tones so that others may understand clearly in an office setting and on the telephone; be able to independently travel to multiple work locations during the course of a day and/or week; physical agility to lift up to 25 pounds. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Duties are normally performed in a public setting in the community/school/office environment. The noise level in the work environment is usually moderate.

PG 14/Non-exempt