Medicaid Implementation Admin

JOB SUMMARY

Serves as the e-SHARS System Application subject matter expert for client district customer support representatives and SHARS Clinicians.  Provides training to HISD and client school districts on research, program development, implementation, and service provider licensure. Certifies Medicaid requirements for HISD t and each client district’s Medicaid revenue programs. Responsible for managing HISD and client district accounts, by monitoring, analyzing, and coordinating on-going operations to maximize Medicaid revenue and meet state/federal Medicaid regulations and requirements.

MAJOR DUTIES & RESPONSIBILITIES

• 1.    Monitors and ensures medical claiming and processing guidelines are followed. Analyzes day-to-day activities, solves and prioritize assignments. Trains client district administrators, clinicians, and health and related service providers on the e-SHARS  system and Medicaid  regulatory and audit compliance requirements.
  2.    Routinely travels throughout the state of Texas to provide Medicaid program policy and regulations and eSHARS system training and support to our client districts. Meets with assigned client districts on infrastructure, on-going operations, cloud-based data systems, and other support services to ensure maximum Medicaid revenue and program compliance is achieved.  Provides new client district programs with infrastructure development to implement new school-based Medicaid programs.
  3.    Coordinates and supports the resolution of client district customer concerns and issues. Consults with client district’s school district administrators to establish monetary and regulatory compliant goals to achieve maximization for their district’s Medicaid revenue.
  4.    Acquires, compiles, and maintains current program operations data and criteria to ensure infrastructure operations effectiveness to applicable policies and performs client district program audits to meet state/federal compliance.

MAJOR DUTIES & RESPONSIBILITIES CONTINUED

• 5.    Coordinates with the Technology team and outside contractors to upload data, analyze and resolve issues, and provide input for programming and system development of the  on-line system application.  Assist with system testing and quality assurance operations prior to system production releases of software.
  6.    Prepares and files required reports to ensure client districts compliance with state and federal Medicaid requirements, including mission-critical Medicaid, SHARS Cost Reports, Certification of Expended Funds (COEF) and Maintenance of Effort (MOE) compliance to USHHS Office of Inspector General (OIG) disclosures.
  7.    Ensures that HISD’s contractual responsibilities and duties, pursuant to an executed Interlocal Agreement (Contract) with client districts, are being met with appropriate span of control protocols and managerial oversight, infrastructure development, variance analysis, reporting, and client dialog interface. 
  8.    Performs other job-related duties as assigned.

EDUCATION

Bachelor's Degree

WORK EXPERIENCE

1-3 years

SKILL AND/OR REQUIRED LICENSING/CERTIFICATION

SAP-OneSource preferred, Microsoft Office/365 Suite, Power Schools and Special Education Data Management System’s experience preferred Office equipment (e.g., computer, copier)

LEADERSHIP RESPONSIBILITIES

No supervisory or direct people management responsibilities. May provide occasional work guidance, technical advice and training to staff.

WORK COMPLEXITY/INDEPENDENT JUDGMENT

Work involves the application of moderately complex procedures and tasks that are quite varied. Independent judgment is often required to select and apply the most appropriate of available resources. Ongoing supervision is provided on an "as needed" basis.

BUDGET AUTHORITY

Participates in a group plan and/or budget development.

PROBLEM SOLVING

Decisions are made on both routine and non-routine matters with some latitude, but are still subject to approval. Job is occasionally expected to recommend new solutions to problems and improve existing methods or generate new ideas.

IMPACT OF DECISIONS

Decisions have minor, small and possibly incremental impact on the department or facility. Errors are usually discovered in succeeding operations where most of the work is verified or checked and is normally confined to a single department or phase of the organizational activities resulting in brief inconvenience.

COMMUNICATION/INTERACTIONS

Information sharing - gives and receives information such as options, technical direction, instructions and reporting results. Interactions are with customers, own supervisor and coworkers in own and other departments.

CUSTOMER RELATIONSHIPS

Takes routine or required customer actions to meet customer needs. Responds promptly and accurately to customer complaints, inquiries and requests for information and coordinates appropriate follow-up. May handle escalated issues passed on from coworkers or subordinates.

WORKING/ENVIRONMENTAL CONDITIONS

Work is normally performed in a typical interior work environment which does not subject the employee to any hazardous or unpleasant elements.
Ability to carry and/or lift up to 45 pounds or more.