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School Health Services Medicaid Specialist

Company: Mesa County Valley School District 51
Location: hawthorne
Posted on: May 3, 2021

Job Description:

Position Type:
Administrative Support Staff/Specialist

Date Posted:
4/7/2021

Location:
Hawthorne Building

Date Available:
2020-21

Job Title: School Health Services Medicaid Specialist

Pay Program: Support Staff

FLSA Status: Non-Exempt

Reports to: Coordinator, Nursing and School Health Services

Pay Range: CX03
Range starts at: $45,893

Reviewed/Revised Date: March 2021

Work Year: Year Round

VISION: To Engage, Equip, and Empower our learning community today for a limitless tomorrow.

SUMMARY: Operating under the general supervision of the Coordinator for Nursing and Health Services and guided by the Colorado Department of Education, the SHS Medicaid Specialist provides the primary oversight of the Medicaid administrative and systems. Responsibilities cover array of activities including the coordination and submission of daily and quarterly Random Moment in Time Studies (RMTS). This role works with Medicaid's Public Consulting Group (PCG) to ensure accurate reporting and our compliance with Medicaid requirements. Employee is in charge of all Medicaid claims submissions and cost reporting and is the primary contact for audit or program review questions. This Specialist role works with staff in EzEdMed software training needs and manages the parental consent processes. Other responsibilities include participation in the District's Health Advisory Committee and our Medicaid Local Service Plan. The SHS Medicaid Specialist champions these efforts providing leadership and enthusiasm for our SHS Medicaid Program to include participation, oversight and compliance.

ESSENTIAL DUTIES AND RESPONSIBILITIES: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Job Responsibility Descriptions

  • Assisting the Coordinator for Nursing and Health Services, the Medicaid Specialist oversees the D51 activities for RMTS and as required as part of our Medicaid Administrative Claiming and Cost Reconciliation and Settlement reporting. The RMTS use a verifiable, statistically valid random sampling technique that produces accurate labor distribution results. These results are used to identify the proportion of administrative and direct services time that are allowable and reimbursable. The Specialist develops and maintains the staff roster of employees required to participate in RMTS including certifying time study participants meet the educational, experiential, and regulatory requirements for this program. Participants are divided into staff pools and the Specialist manages, monitors and tracks completed RMTS between Direct Service Providers, Targeted Case Management Providers and Administrative Providers submitting quarterly reports as required.
  • This employee is the point of contact for internal staff required to complete RMTS, providing regular trainings for new participants/providers and regularly communicating program changes or updates to all affected staff. This person is also the primary contact for external agencies and coordinates with Medicaid's Public Consulting Group (PCG) and Health Care Policy and Financing (HCPF) group in submitting and updating applicable District and school-based information. This role also maintains program's accountability and compliance through accurate and detailed provider licensure documentation that meets Medicaid reimbursement eligibility.


  • Claims submission for Medicaid is a highly compliance driven process and the Specialist acts as a technical resource regarding Medicaid SHS programs ensuring our adherence to established regulations and our ability to submit accurate reimbursement claims. Responsibilities in this area include reviewing student's Individual Education Plans (IEP) and other plans that are allowed with the Medicaid expansion program to ensure services are clearly defined and for language that matches Medicaid claiming purposes. Training and staff education around IEP language or other allowable expansion programs is a collaborative effort with Special Education Coordinators. Other staff training is centered on a combination of paper documentation and the use of the ezEdMED software.


  • The Medicaid Specialist also creates internal systems centered on the Medicaid parental consent process and documents. Duties in this area include talking directly with parents, teaching IEP teams the parental consent process, tracking submissions and following up on missing documentation. The Specialist is responsible for implementing and maintaining a process to ensure Medicaid documentation is completed accurately and timely. Duties included in this responsibility involve conducting internal reviews comparing actual Medicaid expansion programs and IEP services to Medicaid claims documentation. The review of claims reports also includes but is not limited to verifying supporting documentation, maintaining service provider qualifications, preserving parental consent forms and service logs. As the primary contact for our consortium billing agent; this person is also responsible for participating in Program Reviews completed by PCG/HCPF by producing supporting documentation and providing answers to inquiries for claims and program processes.
  • Another area of claims related responsibilities involves tracking and appropriately billing for Medicaid eligible student transportation. Employee works closely with Student Transportation of America (STA) leadership to maintain a process to monitor, document, and report each one-way ride for eligible students. This reporting is then integrated as a part of the overall claims processes this Specialist oversees.


  • Cost reporting for SHS Medicaid is done quarterly with an annual report as well. The Specialist prepares and submits cost reports with a high expectation for accuracy and timeliness using established checks and balances to ensure data integrity. The employee is overseeing the Medicaid budget with both revenues and expenditures documented accurately. This employee also creates an Annual Report of Expenditures. Responsibilities in this area require active collaboration with Payroll, Finance and other departments as necessary to facilitate salary and benefits reporting. PCG/HCPF agencies conduct Desk Reviews periodically and the employee produces supporting documentation and answers to inquiries. Other annual reports include Colorado Department of Education (CDE) requirements to match actual expenditures to our Local Services Plan (LSP).


  • SHS Medicaid Local Services Plans (LPS) are created every five (5) years and this role ensures the district's compliance with the plan on record including submitting regular updates. LSPs require a Health Advisory Committee to include community members and agencies serving or targeted to Medicaid programs and internal departments participating in Medicaid related activities/services. This role guides this committee work to help identify unmet health needs or create Medicaid Outreach and enrollment efforts in schools. Specialist may provide training to staff on Medicaid referrals and this employee may also participate in department projects to develop new services or evaluate current services, programs or staffing.


  • Perform other duties as assigned


EDUCATION AND RELATED WORK EXPERIENCE:
Associates of Arts or Applied Sciences Degree from an accredited institution required*;
Note: due to the specialized skill set required for SHS Medicaid Program management relative extensive experience may be substituted in place of required Degree
Minimum two years of experience Medicaid billing, case management or program record keeping/billing required;
Preference given for prior school district office, finance, administrative, or special education support staff experience;
Bilingual oral and written skills, English/Spanish, are desirable;
*Acceptable demonstration of education and/or experience is at the sole discretion of the district.

LICENSES, REGISTRATIONS or CERTIFICATIONS:
Must successfully complete a criminal background check required for hire;
Valid Colorado driver's license or identification required;
Attend and successfully complete all staff development training as required by state law or as directed by supervisor.

SKILLS, KNOWLEDGE & ABILITIES:
Community Awareness - This Support Staff role brings a basic knowledge of local cultural and educational diversity as it relates to understanding SHS Medicaid processes and procedures and how they interrelate with District services. This position is responsible for supporting District personnel in understanding how to foster success for all students regardless of gender, race, or ability.
Legal Knowledge Base - SHS Medicaid Specialist holds an expectation to possess a base knowledge of and promote and enact federal, state, and District education policies, standards, and procedures. This role supports District personnel in understanding and abiding by legal and ethical boundaries as outlined in the:
Health Insurance Portability and Accountability Act (HIPAA, 1996),
Children's Online Privacy Protection Act (COPPA 1998),
Every Student Succeeds Act - Title I, Title II, Title III (ESSA 2015),
Individuals with Disabilities Education Act (IDEA, 2004),
Title VI of the Civil Rights Act (1964),
Americans with Disabilities Act (ADA, 1974) and Section 504 of the Rehabilitation Act,
Family Educational Rights and Privacy Act, (FERPA 1974, 2016),
Exceptional Children's Education Act (ECEA, 2013).
Other Skills and Awareness - This Specialist role must also possess basic skills that include:
Exceptional English communication and phone etiquette skills in English;
Ability to use Spanish oral communication skills is desirable;
Exceptional customer service, and interpersonal relationship building skills;
Exceptional written communication skills including consultive abilities;
Exceptional ability to pay attention to detail and work independently as needed with minimal direction and/or supervision;
Well-developed ability to research, display, and explain complex information/data in an understandable format;
Well-developed writing, organizational, scheduling, report writing and record keeping skills;
Ability to use de-escalation skills to diffuse and manage stressful and fluid situations;
Ability to maintain confidentiality in all aspects of the job; especially related to student information and IEP reports;
Ability to manage multiple priorities and frequent interruptions in a timely manner;
Ability to be adaptable and flexible with collaborative critical thinking and problem solving capabilities;
Ability to promote and follow Board of Education policies, building and department procedures;
Ability to communicate, interact and work effectively and cooperatively with people from diverse ethnic and
educational backgrounds;

Ability to recognize the importance of safety in the workplace, follow safety rules, practice safe work habits, utilize appropriate safety equipment and report unsafe conditions to the appropriate administrator.

MATERIALS AND EQUIPMENT OPERATING KNOWLEDGE:
Expert knowledge of and experience with personal computers and peripherals;
Operating knowledge of and experience with typical office equipment, such as scanner, copier, fax machine, etc.
Operating knowledge of and experience with software programs for presentations, word processing, spreadsheets, Smartsheet, and online computing platforms including G+ Suite and Office 365 integrated educational packages;
Working knowledge of District 51 School Health Services Program Manual within 30 days of hire required;
Operating knowledge of the EzEdMed Software program within 30 days and expertise within 90;
Operating knowledge for the District's student tracking software required within 30 days of hire.

Keywords: Mesa County Valley School District 51, Hawthorne , School Health Services Medicaid Specialist, Other , hawthorne, California

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