LTSS Specialist 2

Under supervision of the HCBS Administrator, the LTSS Specialist 2 supports the program teams with capturing documentation required for billing services and supports. Tasks include ensuring accurate database records, creating, reviewing and distributing billing reports, and responding to billing issues and exceptions. In addition, this position is responsible for adjusting previously submitted claims and tracking the status of implemented billing resolutions. The LTSS Specialist II is expected to demonstrate LTSS and database expertise, in addition to excellent problem-solving skills, and to work independently and collaboratively across teams.

Job-specific Duties And Responsibilities

Inclusion & Engagement for People Supported

• Facilitate and model inclusive interactions and relationships.
• Promote increased independence in all aspects of life for people supported, with an emphasis on community engagement.
  
  

Database Services, Schedules & Service Logs

• Execute process for ensuring approved service units are correctly entered into database after PCP approval.
• Ensure services and staffing patterns align with approved funding.
• Perform audits of service logs to ensure payment criteria is met, reporting deficiencies to appropriate supervisor(s) for corrective action.
• Ensure missing service logs are documented in database, reporting deficiencies to appropriate supervisor(s) for corrective action.
• Identify patterns associated with incorrect/missing service logs and schedules and develop mitigation procedures.
  
  

Billing Support

• Maintain collaborative relationships with internal teams to ensure an efficient and effective LTSS billing process.
• Prepare and distribute billing reports, highlighting areas where scheduled service units do not align with recorded service units.
• Support Finance at billing submission and respond to issues raised during the billing process.
• Identify patterns associated with billing process delays and develop mitigation procedures.
  
  

Billing Exceptions

• Monitor LTSS for billing exceptions, alerting appropriate team members to outstanding issues.
• Collaborate with internal team members to investigate and resolve billing exceptions.
• Adjust previously submitted billing claims in LTSS as required to align with outcome of investigation or changes in approval status.
• Track status of implemented billing resolutions until pending claims are paid or discarded, as appropriate.
• Maintain adequate documentation for all billing claims submitted, adjusted, and discarded.
  
  

Documentation and Recordkeeping

• Regularly produce reports which compare scheduled and approved units to reduce delivery of unfunded services.
• Prepare employee evaluation reports and provide to supervisors when needed to address documentation issues.
• Ensure written records which meet identified standards and include accurate data that supports funding requirements are maintained as required.
• Perform regular reviews to ensure compliance with policies and procedures.
  
  

Qualifications

• Master’s degree plus two years of relevant professional experience, or bachelor’s degree plus four years of relevant professional experience, or high school diploma plus eight years of relevant professional experience. 30 credit hours may be substituted for one year of experience.
• Experience working with the Maryland Developmental Disabilities Administration’s LTSS billing system or with a Medicaid provider database system (preferably CIMS).
• Proficiency across the MS Office product suite.
• Commitment to a high standard of ethics and protecting confidential information.
• Effective verbal and written communication skills and computer skills.
• Ability to read and write fluently in English and have a good understanding of the English language.