Medicaid Waiver Coordinator

Job Description

Job Description

Position Goal / Function

Under the direction of the Medicaid Services Manager, a Medicaid Waiver Coordinator serves as the agency’s specialist for Medicaid Waiver related services, authorizations, reimbursement integrity and compliance.

The position is responsible for oversight, analysis, processing and reconciliation of all Payment Authorizations for Waiver Services (PAWS) activities for waiver recipients at GCBDD ensuring accurate authorization, billing compliance, fiscal stewardship, and maximization of Medicaid Reimbursement.

The position functions as a subject matter expert on waiver funding, cost projection tools (CPTs), reimbursement regulations and DODD systems requirements and provides subject matter assistance to Service & Support Administrators (SSAs), supervisors, providers and stakeholders.

Essential Functions

• Serves as the primary staff responsible for entry, revision, and reconciliation of all waiver service authorizations in DODDs Medicaid Services Systems (MSS).
• Reviews and analyzes Cost Projection Tools (CPTs) for accuracy, compliance and fiscal impact.
• Monitors waiver budgets; identifies over-budget/over-utilization trends and initiates prior authorization (PA) processes when necessary.
• Stays up to date on DODD/HCBS rules, changes to rules, system maintenance and adjusts accordingly.
• Processes specialized waiver requests, including DODD approved nursing and environmental modifications and equipment.
• Researches and resolves complex provider billing errors and over billing situations.
• Collaborates with providers and internal departments to correct errors and prevent recurrences.
• Assist in the waiver enrollment process for all DODD/County Board administered waivers (e.g. Individual Options, Level I, SELF Waivers).
• Maintaining DODD waiver allocation systems for waiver enrollment opportunities
• Disseminates and monitors PLOM and Patient Liability status and works with Internal/External Departments to resolve enrollment issues.
• Assist in the County Transfer process for sending and receiving of waiver recipients across the state.
• Maintains re-determination and CPT tracking systems to ensure compliance with submission timelines.
• Maintains tracking systems for county transfer, PA and waiver enrollment/dis-enrollment.
• Provides training and technical assistance to SSA, supervisors, providers and stakeholders regarding rule, CPT development, reimbursement parameters, compliance, orienting and training new staff etc.
• Presents material and knowledge to explain what Waiver Services are available to waiver eligible individuals, families and guardians.
• Gather information regarding Medicaid waiver services, that may be required in advance of assessments, evaluations, funding discussions, waiting list planning, committee meetings, etc
• Maintenance and management of DODD’s IDS/LOC/Assessment Center for the purpose of data integrity.
• Complete NICS as necessary including any needed follow-up and maintaining of timelines for the purpose of data integrity.
• Maintains and follows established departmental standards for electronic file organization, documentation, email communication, record keeping, and tracking systems to ensure consistency, accessibility, accountability, and effective collaboration across the team, including in a remote work environment.
• Promote and implement the mission and goals of the Board in a professional, positive and efficient manner.
• Consistent and predictable attendance.

Performs related duties as required.  Any one position may not include all of the duties listed, nor do the examples cover all the duties that may be performed.

Required Knowledge, Skills, Abilities

Knowledge of: Interviewing techniques, human relations, state and federal laws, rules & guidelines pertaining to clients’ rights; Medicaid Waivers; Greene County Board of DD Policies and Procedures.

Skills in:
Interpersonal skills with co-workers and the public in a respectful, positive and pleasant manner; Maintain confidentiality; Basic computer skills; organization; basic math; writing skills; quality customer service.

Ability to:  Work at a computer workstation for extended periods in the performance of essential job functions. Respond appropriately to health, safety, or behavioral concerns involving individuals served, consistent with agency protocols. Occasionally transport or move office materials or documents.

Qualifications

• Bachelor’s degree from a 4 year college or equivalent proven work experience.
• Must have valid Ohio driver’s license and maintain a driving record in compliance with Greene County Board of DD policy.
• As required by law or rule, must successfully pass a criminal background check through OH BCII, Nurses Registry, Office of Inspector General check, ODODD Abuse Registry checks and any other required checks by law.
• Following a conditional offer of employment, must successfully complete a job-related post-offer medical examination and drug screen.
• Three years’ experience in PAWS or Medicaid billing preferred.