Medicaid and Quality Assurance Coordinator

DISTINGUISHING FEATURES OF THE CLASS: This position exists in the Schenectady City School District and involves responsibility for the review and assembly of documentation to support Medicaid claims to the New York State School Supportive Health Services Program. Duties performed are primarily focused on the specialized programmatic tasks relating to using computer-based applications/software to support Medicaid reimbursement for clinical services provided to district students with disabilities. The work is varied with many complex moving parts to ensure compliance and is performed under the general direction of the Assistant Superintendent of Student Support Services with leeway given for the exercise of independent judgment in dealing with established Medicaid guidelines. Does related work as required.

TYPICAL WORK ACTIVITIES:

• Reviews and processes claims and related documentation for completeness and accuracy in accordance with NYS and federal guidelines and regulations;
• Monitors accuracy of digital documentation;
• Monitors compliance of prescriptions, documented sessions, evaluations, USO (Under the Supervision of)/UDO (Under the Direction of) documentation and IEP accuracy;
• Resolves documentation discrepancies;
• Trains staff in processes and procedures and sets up users in the billing software;
• Analyzes and monitors claim submissions;
• Compiles statistics on timely submissions;
• Routinely monitors providers' license verifications;
• Runs queries to monitor the status of scripts, evaluations and USO/UDO compliance;
• Routinely monitors the activity and history of each provider using the billing software;
• Updates the providers and users in the billing software as needed;
• Provides reports on the status and findings of Medicaid audits;
• Communicates audit observations, recommandations and process improvements;
• Coordinates auditing outcomes with Medicaid Compliance Officer to identify, develop and publish corrective actions/educational material related to audit errors;
• Prepares original correspondence to employees and other clientele on a variety of Medicaid related issues;
• Provides annual Welcome Back to all users/staff with Q&A instructions on Medicaid requirements;
• Maintain monthly USO/UDO monthly/quarterly logs and ensure compliance with timely submission;
• Prepares reports that maintain the vitality of the Medicaid revenue;
• Maintains electronics and hard copy files and records as required;
• Coordinates the development of processes and procedures;
• Assists to ensure compliance with all applicable federal and state laws;
• Performs a variety of data entry of information into various systems used by the district/department;
• Performs other duties as assigned consistent with the goals and responsibilities of this position and as directed by the Assistant Superintendent of Student Support Services or his/her designee.

FULL PERFORMANCE KNOWLEDGE, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS: Comprehensive knowledge of the rules and regulations of the New York State School Supportive Health Services Program; thorough knowledge of Microsoft Office Suite; good knowledge of English; Good knowledge of the principles and practices involved in the organization of record keeping; ability to understand and carry out complex oral and written instructions; Ability to understand, use and explain complex regulations to others both orally and in writing in a clear and concise manner; ability to detect and define reporting irregularities and give recommendations on effective corrective measures; ability to prepare factual, clear and comprehensive analyses and to make sound recommendations; ability to create and use complex spreadsheets and databases; ability to acquire a knowledge of technical medical terminology and

usage; ability to establish good working relationships with clinicians and other staff members at all levels as well as those from outside agencies/schools; ability to manage a heavy workload and work with a high degree of independence to meet goals and deadlines; ability to deal with controversial matters in a tactful manner; ability to maintain confidential information; excellent analytical, problem-solving and decision making skills.

SALARY: Per CSEA Contract

LOCATION: Central Office

QUALIFICATIONS:

SPECIAL REQUIREMENTS

Must obtain, within 52 weeks of appointment, the necessary auditing/coding certifications with the American Academy of Professional Coders and maintain certification for the duration of employment.