SY 25-26 Risk Management Lead Technician

PRIMARY FUNCTION: Under the general supervision of the Human Resources Director of Risk Management, the Medicaid Compliance Lead Technician will manage the Medicaid claim program for Risk Management and 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.

REPORTS TO: Human Resources Director of Risk Management

SALARY SCHEDULE: 106

WORK DAYS: 250

REQUIREMENTS:

1. Associate degree from an accredited college or university, with four or more years high-level clerical experience.

Preferred

• Bachelor’s degree in Human Resources Management, Business Administration, Public Administration or related areas.
• One (1) year of experience or knowledge of special education. Experience with school-based Medicaid billing is highly desirable.

1. Experience Skill, and Certification (Required):

• Three or more years of experience with risk management or human resources functions and processes in a business office.
• Considerable computer skills, including data entry accuracy and speed, as well as competence in typical office software products
• Proven ability to understand and follow written or verbal instructions in a timely and accurate manner with attention to detail and the ability to complete work with minimal supervision
• Ability to interact with employees and the public in a tactful and courteous manner, sometimes in trying and difficult situations
• Ability and willingness to perform a variety of tasks and to maintain complete and accurate records.
• Must possess a professional acumen and ability to work with Principals and Administrators. • Demonstrated problem solving and analytical skills
• Demonstrated ability to work under pressure, meeting deadlines on multiple projects
• Ability to prepare and present detailed and complex written and oral reports
• Knowledge of district policies, state and federal rules and regulations related to Medicaid program administration in education.
• Ability to interpret, apply, and explain applicable district policies and procedures.
• Proficient with Microsoft Office (e.g., Word, Outlook, Excel, Power Point, etc.).
• Ability to deal with confidential and sensitive matters in a professional manner.
• Strong written and verbal communication skills.
• Ability to take initiative and seek training to develop knowledge and skills as needs arise. 

ESSENTIAL DUTIES:

1. Ensures all Risk Management technicians are trained and provide guidance as needed.

1. Assists the Director of Risk Management in administering the programs, policies, and procedures of the Department.

1. Recommend and assist in the drafting of policy and regulation changes when necessary and effectively respond to changes within the law and work environment.

1. Ensures HIPAA and FERPA compliance by maintaining confidentiality of all discussions, paperwork, and other information.

1. Monitors Medicaid billing data and systems for both direct (fee-for[1]service) and administrative (ACE) 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.

1. Coordinates all billable services (i.e., skilled nursing, psychology, speech, physical and occupational therapy, etc.).

1. Sends and receives documentation and treatment plans (prescriptions) to physicians and/or providers and enters that information into the district’s Medicaid billing software. Monitors expiration dates of prescriptions with follow up as needed.

1. Analyzes, monitors, audits and corrects financial data in the financial system and provides detailed financial reports as required/directed.

1. Prepares quarterly reports and presents information to Special Education Director and Risk Management Director.

1. Creates, maintains and provides supporting documentation and provider qualifications.

1. Trains district personnel on Medicaid requirements, procedures, and compliance, including consent forms, session notes, etc.

1. Maintains documentation, per state or federal requirements, showing all staff has attended required training sessions.

1. Oversees and maintains Medicaid compliance programs such as random moment time study, narrative logs and coding issues.

1. Create and maintain procedure manuals, documentation, checklists, or guidelines as necessary. Updates training materials as needed.

1. Conducts Medicaid self-audits, documents findings, and provides recommendations for corrective action, if needed.

1. Works closely with parents and staff to obtain parental consent forms.  
2. Maintains confidentiality of student records and personal information.
3. Acts as district liaison with the Medicaid billing vendor, as well as the appropriate government agency. 
4. Updates provider information within the Medicaid billing software.
5. 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.

1. Creates and delivers required surveys, reports, or program information requested by state or federal departments or agencies.

1. May provide some secretarial or clerical duties to the department. Duties typically include answering phones, providing information concerning department or program, word processing, maintaining records or files, monitoring budgets, preparing reports, scheduling appointments, and assisting with coordination of events or activities.

TERMS OF EMPLOYMENT

Incumbents are considered “at will” employees. Appropriate pay will be determined based on the Grade as determined by Human Resources and the incumbent’s allowable experience. This is a 250-day position. Non-Exempt Grade 106 Revised 08/2019

NON-ESSENTIAL RESPONSIBILITIES

A responsibility is considered to be “non-essential” (for the purposes of compliance with the Americans with Disabilities Act) if:

• it is shared between multiple incumbents in the job; or
• it could be performed by an employee in another job within the workgroup.

Note the responsibility number from the list in the “Duties and Responsibilities” section for those responsibilities that could be considered “non-essential” based on this definition.

Certain limited aspects of General Duties and Responsibilities items referenced in Section 1 (b) and (d) might be considered “non-essential” in a specific situation. Any request for accommodation must be reviewed on an “individual case” basis.

PHYSICAL AND SENSORY DEMANDS

Most jobs in the District have physical and sensory demands that can be described by one of the two categories noted below. For jobs that require more physical or sensory effort, please list the requirements in this section. The category applicable for this position is listed below.

{X}OFFICE   Employees in this category are normally exposed to a typical environment. The employee has some control over the length of time sitting, standing, or ambulating. There are occasions that require the lifting or pulling of equipment or supplies, as well as bending, stooping, or stretching. There is frequent use of computers, telephone, and other standard office equipment, which includes reading, listening, writing, or speaking. There are few exceptional physical or sensory demands.

EXCEPTIONAL PHYSICAL OR SENSORY DEMANDS

(Check any that apply to this job and complete the required information.)

[ ] Heavy lifting of up to __25____ pounds

[ ] Frequent climbing up to _______ feet, and/or working on building roofs.

[ ] Exposure to heavy dust, dirt, chemical or paint fumes, or other airborne

matter.

[ ] Exposure to extreme heat, electric current, hazardous chemicals or other

potential hazards.

[ ] Sitting or standing for extended periods with no control over rest periods.

[ ] Other:_ ___________________________________________________

Salary : $24 - $42