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About the Role

This technical position supports the school district's Medicaid compliance and reimbursement operations, involving the review and audit of eligible services and documentation of service delivery.

Responsibilities

Reviews and audits Medicaid eligible services for compliance with State and Federal guidelines, regulations, and laws.
Reviews documentation of service deliveries to support claims for Medicaid reimbursements.
Reviews quarterly progress reports, assessments, contact logs, statements of accessibility, prescriptions, orders, and referrals.
Develops and maintains the district's Medicaid intranet site for documents, forms, training materials, information, and announcements.
Assists in the development of procedure manuals and training for outside agencies.
Maintains supporting documentation for all claims submitted for Medicaid reimbursement.
Develops and maintains multiple databases for Medicaid compliance, including consent, related services attendance, quarterly progress notes, eligible students, demographics, and un-billable students.
Submits documentation and reviews audit defensible claims for Medicaid reimbursement.
Submits claims for Medicaid reimbursement using New York State's software system.

Requirements

Good knowledge of Medicaid eligible services regarding compliance with State and Federal guidelines, regulations, and laws.
Good knowledge of applicable laws, rules, and regulations.
Good knowledge of employer's policies relating to Medicaid reimbursement.
Ability to organize information into reports.
Ability to review claims, reimbursements, and reports.
Ability to monitor related services provided.
Ability to determine if billing is complete and accurate.
Ability to develop and maintain an intranet site.
Ability to assist in the development of procedure manuals and training.
Ability to maintain documentation for Medicaid claims and reimbursement.
Ability to develop and maintain databases.
Ability to establish and maintain effective working relationships.
Ability to communicate effectively both orally and in writing.
Analytical ability.
Good judgment.
Physical condition commensurate with the demands of the position.

Skills

Medicaid compliance
Reimbursement operations
Service documentation
Database management
Intranet site development
Procedure manual development
Training assistance
Claim review
Audit defensible claims
Communication (oral and written)
Analytical skills
Judgment

Experience Level

1 year of paid full-time or equivalent part-time experience in review and submission of Medicaid reimbursement forms, or insurance or medical claims (with Associate's degree)
3 years of paid full-time or equivalent part-time experience in review and submission of Medicaid reimbursement forms, or insurance or medical claims (without Associate's degree)

Education Level

Graduation from high school or possession of an equivalency diploma
Associate's degree in Accounting, Finance, Business Administration, or Business Management (preferred for one experience track)