Medicaid Specialist

General Summary

The Wallowa County Education Service District is seeking a Medicaid Specialist with experience in Medicaid Administrative Claiming (MAC) and Fee-For-Service billing. The MAC program provides reimbursement for claimable work already performed by school district staff. The MAC Specialist provides professional development training to local school district staff and collaborates with WESD and school district business managers and Oregon Department of Human Services.

Position Goal

Provide oversight for the implementation and operations of Medicaid administrative claiming (MAC) and fee-for-service billing to ensure appropriate implementation of Medicaid policy decisions and procedures.

Essential Functions

• Maintain MAC intergovernmental agreements with Department of Human Services (DHS) and sub-agreements with local districts and partners.
• Work as a conduit between DHS and local operations regarding MAC policy and program information, requests for information, frequently asked questions, inquiries of state or federal guidance and other communications.
• Provide timely information to subcontractors regarding MAC training, survey process, cost pool development and claiming.
• Manage all aspects of the MAC quarterly survey process including materials distribution, random selection of survey participants, scoring and summarizing of survey forms.
• Compile, produce and disseminate all MAC claiming reports and the MAC annual report.
• Aid MAC sub-contractors in complying with state and federal guidelines in all MAC applications (i.e. time study process, cost pool development, claiming calculation and training).
• Develop support documentation guidelines and conduct periodic claiming process and file audits with MAC sub-contractors.
• Develop a trainer of trainers consortium and provide MAC training to sub-contractors in compliance with state and federal guidelines including documentation to substantiate training.
• Manage all aspects of the MAC claiming process including review, compilation and submission of quarterly claims, corrections and resubmissions.
• Develop and facilitate the MAC local advisory group in the reinvestment of funds.
• Assist DHS by attending MAC coordinator meetings and assisting state or federal auditors in their work.
• Maintain and update fee-for-service quality control procedures based on Oregon Medical Assistance Program (OMAP) and Education Based Medical Corporation (EBMC) guidelines and audit results.
• Provide training to ESD fee-for-service providers and quality control support personnel regarding current rules, procedures, services logs and other required documentation.
• Cook up and facilitate the MAC claiming process including review, compilation and submission of quarterly claims, corrections and resubmissions.
• Establish and maintain positive, flexible, and collaborative relationships with DHS, ESD and districts.
• Make independent decisions within established policies and procedures.
• Participate in annual professional growth activities.
• Comply with ESD rules and policies.
• Perform physical requirements unaided or with the assistance of reasonable accommodation (see reverse).
• Perform job-related tasks as designated by supervisor.
• Establish and maintain cooperative work relationships with WESD employees, local education agency representatives and others contacted during the course of the workday.
• Some travel required for attending trainings or to present a training.

Minimum Prerequisites

• Experience with Medicaid billing/MAC Survey
• Competence in effective group training, oral and written communication skills, designing and implementing training and documentation systems, coordinating multi agency projects, word processing and spreadsheet applications.
• Previous successful experience in education or health and human services positions preferred.