2627 Special Programs Specialist Medicaid

PURPOSE:

Under the direction and supervision of the Director of Special Education (or designee) oversee and manage the Districts Medicaid program to ensure compliance with state and federal regulations maximize reimbursement and provide strategic oversight of Medicaid billing reporting and provider enrollment processes.

JOB QUALIFICATIONS:

1. Valid AZ DPS IVP Fingerprint Clearance Card
2. Minimum of High School Diploma or equivalent certificate (required)
3. Valid Drivers License
4. Demonstrated experience with Medicaid billing compliance or school-based Medicaid programs
5. Knowledge of special education services IEP processes and Medicaid eligibility requirements
6. Strong analytical organizational and problem-solving skills
7. Ability to interpret and apply federal state and district policies and procedures
8. Exhibited ability to work independently and exercise professional judgment
9. Intermediate to expert experience level in working with Microsoft Suite and Google Suite particularly with excel and google sheets
10. Excellent communication skills and demonstrated ability to work effectively with various stakeholders
11. Evidence of ability to effectively use technology to perform duties
12. Such alternatives to the above qualifications as the Board may find appropriate and acceptable.

ESSENTIAL FUNCTIONS:

Essential functions as defined under the Americans with Disabilities Act may include any of the following knowledge skills abilities duties and responsibilities and physical requirements. This list is ILLUSTRATIVE ONLY and is not a comprehensive listing of all duties and responsibilities

performed by incumbents of this class.

KNOWLEDGE SKILLS ABILITIES:

• Knowledge of using email managing files recording and reporting grades electronically and using Google applications.
• Strong analytical and problem-solving skills with a high degree of accuracy and attention to detail.
• Excellent organizational and time-management skills with the ability to manage multiple priorities and meet deadlines.
• Strong interpersonal and communication skills with the ability to explain complex financial information to a variety of audiences in both written and oral form.
• Ability to read and interpret written material in print or electronic format.
• Ability to work independently and as part of a team.
• Ability to maintain confidentiality and exercise discretion.
• Ability to perform functions from written and oral instructions and from observing and listening to others.
  
  

DUTIES AND RESPONSIBILITIES:

• Oversee the Districts Medicaid program to ensure compliance with all federal state and district regulations.
• Prepare and submit quarterly and annual cost reports providing a detailed and accurate account of program expenditures.
• Prepare review and submit Reports on Provider Activity (ROPA)
• Manage the provider enrollment and revalidation process including adding and removing billable providers.
• Monitor overlapping service reports Random Moment Time Study (RMTS) data and other compliance indicators.
• Maintains reports and documentation in preparation for agency related audits and any other program-specific audits.
• Audit and verify Medicaid billing for all providers prior to claim submission and resolve complex billing issues or denials.
• Creates and disseminates clear concise and useful financial reports and analysis for various stakeholders.
• Serve as the primary point of contact for external audits monitoring reviews and compliance inquiries.
• Process and approve Health Aide Authorizations for service minutes exceeding established thresholds.
• Assists with the development and update of District procedures ensuring they align with district policies and Federal and State law and regulation.
• Conduct Medicaid training sessions for providers to ensure accurate documentation and billing practices.
• Collaborate with the Employee Relations Department to ensure meeting with new special education staff particularly paraprofessionals to provide program orientation and guidance upon hire and to ensure employees are removed from the system upon separation.
• Maintain high-level oversight of staff pool lists and contracted provider documentation.
• Process and authorize requisitions and purchase orders related to Special Education Medicaid services.
• Assist administration with expanding Medicaid billing opportunities and improving revenue capture.
• Maintains professional and technical knowledge by attending educational workshops reviewing professional publications establishing personal networks and participating in professional societies to stay informed of current regulations and compliance requirements.
• Support continuous improvement by recommending process efficiencies and internal control enhancements.
• Maintain a high level of ethical behavior.
• Perform other duties as assigned.

PHYSICAL REQUIREMENTS:

The physical demands described here 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 to perform the essential functions. While performing the duties of this job the employee is frequently required to sit stand walk speak and hear. Specific vision abilities required by this job include close vision such as to read handwritten or typed material and the ability to adjust focus. While performing the duties of this job the employee may occasionally push or lift up to fifty (50) pounds such as boxes supplies etc. The position may require the individual to meet multiple demands from several people simultaneously or prioritize the demands and to interact with the public and other staff in person verbally and/or in written form.

WORKING ENVIRONMENT:

Office some travel to school sites meetings and professional development activities. 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. The work environment is an office environment within a school district office setting. The noise level in the work environment is moderate to moderately high during the work day. There may be periods of recurring stress in the performance of this job. The typical workday occurs during regular business hours; however on occasion and dependent on reports and other timelines evening or weekend work may be necessary. Driving to and from work sites may be required from time to time.

Terms of Employment:

• Full Time 40 hours/week Non-Exempt
• 12 Month Work Calendar
• Earned Paid Sick Time (up to 5 days)
• Personal Business Leave (up to 7 days)
• Vacation accrual based on tenure (up to 5-15 days)
• Mandatory participation in the Arizona State Retirement System (ASRS)
• District fully paid Medical Dental Vision and Basic Life Insurance & AD&D benefits for employee only

Required Experience:

IC