Job Description:

Position Title: Lead Medicaid Specialist
Location: Leidal Education Center
Department: Special Education and Behavioral Health & Wellness
Reports To: Directors of Special Education and Behavioral Health & Wellness
Term: Year-round position
Schedule: Mon-Fri Full-time

SUMMARY: Under the guidance of the department Directors, the essential function of the Lead Medicaid Specialist is to develop, implement, and manage the Medicaid revenue reimbursement opportunities in the District in accordance with applicable rules and regulations for learner services (IEP and Non-IEP) provided in a school setting.
 
The position is responsible for overseeing the functions of Medicaid, establishing and maintaining client records, confirming viability and supporting the initial eligibility process for approved school-based services, monitoring Medicaid funding, and reporting/actioning on data.
 
Additionally, the Medicaid Specialist will provide training to providers and monitor participation in required Medicaid procedures, and will serve as the primary point of contact for all Medicaid program activities.
 
QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty and requirement satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required for the role. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
 
ESSENTIAL DUTIES AND RESPONSIBILITIES: (Other duties may be assigned)
Collaboration:
Manages the District's role in the network system for billing of Medicaid using on-line system agreed upon and collaboratively operated between the District and the Regional Education Agency.
Collaborates with providers on required documentation for billing which includes, but is not limited to, enrollment, affiliation, required service notes, etc.
Trains and supervises the work of personnel involved in entering learner Medicaid records; trains providers in documenting services in accordance with regulatory rules and regulations and District procedures; reviews and submits data to regulatory agencies as required. 
Collaborates with Regional Education Agency on: 
Medicaid Performance Reports (monthly and quarterly) and arranges continuous program improvement processes.
Communicating and monitoring required service delivery, billing reports, and audits in accordance with Medicaid policies and procedures. 
Facilitates action steps using information from reports and/or audits.
Develops positive, effective working relationships with learners and staff.
Communication:
Connects and shares ideas through appropriate/applicable formats to express thoughts and ideas with integrity.
Compassion:
Understands the complexities of cultural and global issues and how they relate to employee and learners’ experiences.
Partners with others to resolve potential controversy and conflict through respectful discussion.
Proactively seeks to understand the ideas, opinions, and skills of others.
Creativity:
Connects with team members and shares ideas in an effort to improve the overall learner and employee experience.
Critical Thinking:
Prepares and maintains revenue data to show performance within the year and across multiple years.
Identifies Medicaid-eligible learners and implements procedures for ongoing identification and verification of eligibility.
Reasons, interprets, and analyzes information to generate new knowledge and understanding.
Reflection:
Acquires and maintains knowledge of current Medicaid rules, statutes and government guidelines pertaining to learner services (IEP and Non-IEP) provided in the school setting, including, but not limited to, physical therapy, occupational therapy, speech therapy, nursing services, behavioral health therapy, and learner educational evaluations. 
Proactively seeks out professional learning opportunities to ensure program compliance across the District with applicable laws, regulations, policies, procedures and administrative requirements.
Maintains communication with supervisor and director regarding general feedback, career advancement opportunities, and areas of growth opportunities.
Resilience:
Ensures work is done with fidelity to Medicaid guidance and in a timely and consistent manner.
Maintains composure while dealing with stressful situations.
Proactively seeks out resolutions and takes initiative to resolve knowledge gaps.
Responsibility:
Manages the Medicaid claim program for IEP and Non-IEP services, including data management of learner claims, parent consent, and provider information.
Develops and implements procedures for Medicaid documentation and reimbursement, ensuring compliance with federal and state regulations.
Establishes learner services (IEP and Non-IEP), provider credentials, and facilitates the authorization process with providers.
Performs general administrative/clerical duties as assigned, including data entry, managing correspondence, organizing and maintaining documents, answering/returning phone calls and initiating/responding to electronic messages.
 
PHYSICAL DEMANDS AND WORK ENVIRONMENT: The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the essential duties and responsibilities of this role, the employee is regularly required to reach with hands and arms.
While performing the essential duties and responsibilities of this role, the employee is regularly required to stand, walk, bend, talk, and hear.
The specific vision abilities required for this role include close and peripheral vision.
The employee may be required to lift up to ~30 pounds.
The employee must work with the public and various WFPS staff while simultaneously managing several competing demands.
The employee will work in an environment that has a quiet to loud noise level.
 
Education and/or Experience:
Bachelor’s Degree in a field such as healthcare administration or closely related field OR equivalent professional experience (4+ years) in billing Medicaid.
Previous professional experience in Medicaid billing, healthcare administration, or a related field is required.
Minimum 1+ year if applicant possesses Bachelor’s degree requirement or minimum 5+ years (4 years for Bachelor’s equivalent + 1 year of professional experience) if applicant does not possess Bachelor’s Degree.
Demonstrated effective organizational, communication, and data management skills.
Demonstrated familiarity with Medicaid regulations and billing processes.
 
Language Skills:
Ability to read, write, and comprehend simple instructions and short correspondences in the English language.
Ability to communicate effectively verbally, expressively, and reactively.
 
Other Skills and Abilities:
Exercise confidentiality, discretion, and good judgment.
Adhere to the assigned work schedule by maintaining regular and punctual attendance.

SUPERVISORY RESPONSIBILITIES:
None.

Salary: Position follows the 2024-2025 Classified Salary Schedule at B243. Starting salary begins at $24.90-$27.15/hour, based on experience - https://www.west-fargo.k12.nd.us/departments/human-resources/salary

To Apply: Please complete the application and include three references.