Medicaid Compliance Specialist Job at Conroe Independent School District
Conroe Independent School District Conroe, TX
The Medicaid Compliance Specialist is responsible for overseeing the School Health and Related Services (SHARS) and Random Moment Time Study (RMTS) programs for special education services. Assist campus Admission, Review and Dismissal and Review (ARD) managers to ensure Individual Education Plan (IEP) documentation maximizes compliance with Medicaid billing standards and accuracy of Public Education Information Management Systems (PEIMS) data. Improve efficiency and accuracy of the SHARS billing process, provide training to campus direct medical service providers and monitor the documentation of all medical services to ensure completion. Review and analyze district data to continuously improve the district process for maximizing reimbursement on the SHARS Cost Report and stay up to date on regulations and best practices for the billing process.
- Ensure program compliance with all State and Federal regulations related to Medicaid Program in schools.
- Provide follow up assistance to District staff participating in the RMTS/SHARS program.
- Work with the District’s SHARS vendor, the state’s RMTS vendor, and Health and Human Services Commission (HHSC) to address District training and technical assistance needs.
- Monitor claims to ensure services are billed timely.
- Maintain and update Medicaid Administrative Claiming (MAC)/SHARS participant list.
- Provide support and documentation of Special Ed (Program side) needed by independent auditors.
- Complete annual training requirements for SHARS, MAC and RMTS program.
- Create and review student data reports to make sure Medicaid eligible students’ services are being documented and billed out and Medicaid parental consents are entered into Medicaid billing system.
- Oversee day-to-day support for Medicaid and IEP/ARD compliance and regulations.
- Review and adjust participant list quarterly.
- Ensure all participants selected for the RMTS are completing the mandatory survey within 5 business days.
- Ensure service providers (participants) are documenting and billing for Medicaid eligible students’ services.
- Meet, train and communicate with IEP manager to show them areas where they can improve documentation within the IEP, including the transportation forms, personal care supplements, and related services sections of the IEP.
- Provide data documentation training for all District staff involved with special student services and programs.
- Train and assist the work of personnel involved in entering student/Medicaid records; train providers in documenting services in accordance with regulatory rules and regulations and District procedures; review and submit data to regulatory agencies as required.
- Serve as liaison for the District and Medicaid vendor regarding registration for National Provider Identification (NPI) number with the State of Texas and writing referrals for students for Speech Services.
- Work with the Transportation Department in regards to Special Education Transportation Log compliance and submission to Medicaid vendor. Keep electronic files of transportation logs.
- Set up CISD Special Education Mock Audits with Medicaid vendor at least once per fiscal year to review compliance and identify areas to improve.
- Work with administrators, principals, directors, and staff.
- Compile, maintain, and file all reports, records, and other documents required, including auditable records and financial statements.
- Attend conferences and present any new relevant information to the Diagnosticians, LSSPs, Speech Therapists, Occupational Therapist, Physical Therapists, and other providers as needed.
- Analyze student and provider files with the goal of improving IEP documentation, Parental Consent rates, and RMTS training compliance.
- Verify that all service tickets submitted have required supporting documentation for Medicaid billing, and are complete and correct.
- Maintain all student hardcopy documentation required for TEA or Office of Inspector General (OIG) audits.
- Monitor assessment and ARD timelines for compliance of required federal and state regulations.
- Verify all services being provided are appropriately documented in the student’s IEP.
- Perform other duties as assigned.
- Regular attendance.
- Maintain confidentiality.
Experience:
- Experience with Medicaid billing
- Experience with integrating reports in Microsoft Excel and Microsoft Access
- Experience with data management systems
- Experience working with a diverse population and variety of stakeholders including campus and district level staff
- Experience in training and staff development to school-based assessment staff
Education/Certification:
- Bachelor’s degree
Special Knowledge/Skills:
- Knowledge of special education and related services within a school district
- Knowledge of Medicaid billing and Medicaid definition of billable services
- Knowledge of Medicaid RMTS and Medicaid billing software system
- Knowledge of ARD Committee process and IEP development
- Skill in presenting oral and written information in a comprehensive and organized manner to diverse audiences
- Skill in the use of keyboarding, 10 Key, Microsoft Word, Power Point, Excel, eSped, eSchool, and web based data management systems and software packages
- Skill in gathering and organizing/analyzing data and utilizing various statistical techniques to assist in formulating conclusions and developing recommendations
- Skill in mathematical calculations and detailed work
- Skill in processing a high volume of transactions
- Ability to prioritize tasks and coordinate multiple projects to meet specific deadlines
- Ability to maintain confidentiality of privileged and sensitive information
- Ability to maintain professional behavior, appearance, and work ethic to represent the District in a positive manner at all times
- Ability to communicate effectively with tact and diplomacy and provide a high level of customer service to administrators, District officials, parents, coworkers, and vendors
SUPERVISORY RESPONSIBILITIES:
None
EQUIPMENT USED:
Computer, calculator, copier, fax, and telephone
WORKING CONDITIONS:
Mental Demands/Physical Demands/Environmental Factors:
Maintain emotional control under stress. Prolonged sitting; occasional bending/stooping, pushing/pulling, and twisting.
Occasional district travel; occasional prolonged and irregular hours.
Additionally, once you've logged into your WinOcular application, upload your current resume and letter of interest and ensure your application is updated. Current employees must apply using the internal system. Directors have requested no telephone calls, please.
PAY GRADE: AE-4 - Minimum prorated salary - $73,536
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