Analyst-Medicaid (SBO)

Summary Description:

The Medicaid Analyst serves as the lead contact for the Medicaid and School program for the school division. This role implements the School Based Services Program, ensures program integrity, and provides training and oversight for compliance with Medicaid regulations to ensure the school division maximizes its Medicaid claiming potential. The Medicaid Analyst is expected to know both Medicaid policy and education rules and regulations, including ensuring compliance with state and federal Medicaid laws/regulations, documentation requirements, Department of Education (DOE) regulations, and licensing requirements.

Roles and Responsibilities

The overall nature and scope of the work includes, but is not limited to, the following tasks:

1. Program Implementation & Compliance

• Ensure compliance with state and federal Medicaid laws, documentation requirements, DOE regulations, and licensing rules.
• Develop, coordinate, and deliver professional development and training for school-based and central office staff regarding the Medicaid and School program at least annually.
• Provide updated information and technical assistance to therapists, nurses, paraprofessionals, and other staff as regulatory changes are made.
• Serve as a primary resource for school staff and families on Medicaid provisions and eligibility.
• Attend quarterly Medicaid Coordinators meetings and all mandated Medicaid and School training.
• Prepare utilization reviews for the program to ensure overall local educational agency (LEA) compliance.

2. Billing, Claims, & Financial Coordination

• Manage monthly Medicaid billing, analyze denied claims to determine the cause, and refile claims promptly.
• Ensure the timely submission of reimbursement claims and review Remittance Vouchers.
• Collaborate with the finance department to prepare quarterly administrative claims and the annual cost report.
• Conduct a regular review of accounting procedures and billing reports to meet state Department of Education timelines.
• Collaborate with third-party vendors, the Department of Technology, and Business/Financial Services to resolve data issues and maintain strict data security and student confidentiality.
• Keep all files, logs, and records complete and readily available for audit reviews by the Department of Medical Assistance Services (DMAS).

3. Monitoring & Quality Assurance

• Monitor monthly billing completeness, accuracy, and direct services documentation.
• Monitor parental consent to release educational information for Medicaid billing on an ongoing basis.
• Review and monitor monthly documentation and transportation student logs for accuracy.
• Prepare and match the student Medicaid eligibility list on a quarterly basis.
• Check referring providers monthly to ensure they are registered with DMAS.
• Verify provider licensure and update certification status within the Random Moment Time Study (RMTS) monthly.
• Monitor and report findings on individual providers data entry status monthly

4. Random Moment Time Study (RMTS) Management

• Identify and determine which school division providers meet the requirements to participate in the RMTS.
• Prepare the annual calendar for RMTS participants according to their specific work schedules.
• Maintain and update the RMTS participant list on an ongoing basis, tracking staff changes such as retirements, resignations, or extended medical absences.
• Track and monitor how participant salaries are funded (state, federal, or a percentage of each).
• Train RMTS participants on the importance of the time study and monitor their response rates to ensure organizational compliance.
• Identify and collaborate with key internal stakeholders across finance, special education, student services, transportation, and human resources.

Qualifications

• Education: Bachelor's degree from an accredited university or college.
• Experience: Minimum of three years of experience in financial management and/or reimbursement claims.
• Knowledge & Skills:  Strong knowledge of federal, state, and local regulations and procedures for the implementation of Medicaid claiming.
• Demonstrated leadership qualities and interpersonal characteristics necessary to work effectively with central office personnel, school-based staff, and parents.
• Proven ability to develop and deliver clear, professional development programs regarding complex Medicaid regulations.
• Possess a strong aptitude for autonomous, self-directed learning
• Thrive in independent environments with minimal supervision or instruction.
• Demonstrated ability to proactively manage deadlines and take full ownership of deliverables.
• Resourceful self-starter capable of mastering complex concepts independently.
• Ability to navigate complex stakeholder relationships and effectively manage resistance

Physical Requirements

• Regularly talking, expressing, or exchanging ideas by means of the spoken word to accurately, loudly, or quickly convey detailed instructions to other workers.
• Possession of normal cognitive abilities, including the capacity to learn, recall, and apply complex practices and policies.
• Frequent sitting and remaining in a stationary position for long periods of time.
• Exerting up to 25 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects.

 Pay Rate:

Administrative Support Grade C11 Salary Scale (credit is based on years of full-time experience in a related position)

Assignment:
Full time / 12 months / 245 days

Start Date:

This position is effective with the 2026-2027 school year.  

Salary : $50,439 - $83,073