Medicaid Billing Specialist

Middleton School District 134 Southwest / Boise Posted 3Y ago

About this job

Medicaid Billing Specialist

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.

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 for 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.
Generates report of staff participation, completion, and reimbursements.
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.
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 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 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, 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.

Minimum of High School diploma or GED equivalent.
One (1) year of experience or knowledge of special education.

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 Google or other spreadsheet program.
Knowledge of applicable laws, rules, policies, and procedures as they relate to Federal and State Medicaid laws.
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.
Telephone skills.
Strong interpersonal skills for dealing with public and other office staff.
Ability to accept, receive or collect payment.
Ability to manage budget.

Light work: Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force to move objects. The work also requires the following physical abilities in order to perform the essential job functions: fingering, hearing, kneeling, lifting, mental acuity, speaking, talking, visual acuity and walking.

Employees in this position work in a dynamic environment that requires them to be sensitive to change and responsive to changing goals, priorities, and needs.

Equal Opportunity Employer Statement

Middleton School District 134 is committed to maintaining a work and learning environment free from discrimination on the basis of race, color, religion, national origin, pregnancy, gender identity, sexual orientation, marital/civil union status, ancestry, place of birth, age, citizenship status, veteran status, political affiliation, genetic information or disability, as defined and required by state and federal laws. Additionally, we prohibit retaliation against individuals who oppose such discrimination and harassment or who participate in an equal opportunity investigation.