Medicaid Specialist

POSITION SUMMARY
The Medicaid Specialist is responsible for managing all aspects of Medicaid compliance, billing readiness and program oversight within the district. This role ensures adherence to AHCCCS and federal Medicaid requirements, supports providers, maintains accurate documentation, and coordinates with external agencies to maximize reimbursement and ensure audit readiness.


Disclaimer: The following duties are not intended to serve as a comprehensive list of all duties performed by all employees in this classification, only a representative summary of primary duties and responsibilities. Incumbent(s) may not be required to perform all duties listed and may be required to perform additional position specific duties.

PRIMARY DUTIES AND RESPONSIBILITIES

• Establish and maintain AHCCCS Main and APEP accounts for students and providers to ensure Medicaid eligibility.
• Manage provider accounts within the AHCCCS APEP portal
• Maintain ongoing communication with PCG
• Monitor and manage the Random Moment Time Study (RMTS) program
• Maintain and update the Staff Pool List
• Submit HA Pre-Approvals for applicable IEPs
• Review IEPs to verify Medicaid eligibility
• Submit eligible student IEPs (150+ daily minutes) to PCG for approval
• Track IEP expiration dates and submit updates for continued authorization
• Retrieve reports from IEP Pro
• Upload J-2 and J-3 reports to SEAS monthly
• Securely upload E10ii reports on a monthly basis
• Monitor RMTS responses daily
• Train new providers on RMTS procedures
• Notify providers of missed RMTS entries
• Maintain communication with PCG regarding compliance
• Meet annually with the SEAS account manager to review claim status, unconfirmed claims and financial reporting
• Maintain and update staff names and positions
• Submit updated Staff Pool List to PCG quarterly
• Notify SEAS staff when updates are complete
• Maintain and update the district' s student roster semi-annually
• Include students receiving related services (e.g., Speech-Language, Occupational Therapy, Physical Therapy, Nursing) and/or specialized transportation
• Provide ongoing training to district providers throughout the school year
• Coordinate statewide SEAS training sessions as needed
• Ensure all IEPs meet Medicaid compliance standards
• Coordinate training for IEP authors
• Collaborate with compliance clerks to ensure Activities of Daily Living (ADLs) compliance
• Submit regular enrollment reports to PCG
• Ensure Related Service Providers obtain required documentation (AHCCCS ID, NPI as applicable, Social Security Card, Driver's License)
• Notify SEAS providers of AHCCCS ID numbers, effective dates and NPIs as applicable
• Participate in PCG audits every 4 years
• Participate in single-point district audits
• Participate in Federal PERM audits
• Participate in Annual internal self-audits
• Maintain confidential provider record in secure, locked storage
• Retain provider files for minimum of 7 years
• Ensure ADLs in IEPs comply with CMS and AHCCCS guidelines
• Verify ADLs provided by Special Education Aides include: clearly defined scope, frequency and duration and standardized ADL terminology

KNOWLEDGE SKILLS AND ABILITIES

• Knowledge of Medicaid programs, including AHCCCS policies and procedures
• Understanding of special education processes, including Individualized Education Programs (IEPs)
• Familiarity with Medicaid billing requirements and compliance standards
• Knowledge of Random Moment Time Study (RMTS) procedures and reporting
• Understanding of Activities of Daily Living (ADL) documentation requirements and compliance guidelines
• Knowledge of federal and state audit requirements, including PERM audits
• Familiarity with data systems such as SEAS, PCG platforms, and IEP management systems
• Understanding of provider credentialing requirements (e.g., AHCCCS ID, NPI, certifications)
• Knowledge of confidentiality standards and records retention requirements (e.g., HIPPA, FERPA principles)
• Strong organizational and time management skills to handle multiple deadlines and reporting cycles
• Attention to detail for reviewing IEPs and ensuring compliance accuracy
• Data management and reporting skills, including tracking, auditing, and uploading documentation
• Effective communication skills for working with providers, administrators, and external agencies
• Training and presentation skills to educate staff on Medicaid procedures and compliance
• Problem-solving skills to address compliance issues and resolve discrepancies
• Ability to monitor and enforce timelines (e.g., RMTS responses, IEP renewals)
• Proficiency in using databases, spreadsheets, and web-based systems
• Recordkeeping and documentation management skills

QUALIFICATIONS

• High School Diploma or equivalent
• Experience with SEAS, PCG, or AHCCCS systems preferred
• Experience with IEP compliance and special education processes
• Knowledge of Medicaid programs and school-based services preferred

PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing duties of this job, the employee is required to reach with hands and arm. The employee is frequently required to sit, stand, bend, stoop and walk. The employee may be required to occasionally lift up to 30 pounds.

WORK ENVIRONMENT
Indoor office environment. This position regularly works indoors. The noise level in the work environment is generally quiet to moderate and may become excessively noisy at times. Will have contact with staff and the public.

*****Internal candidates must submit a request for transfer form signed by your site administrator within 5 working days of the posting date. ******


$19.60/hour - 10 Month position - 40 hours/week

EQUAL EMPLOYMENT OPPORTUNITY

Discrimination against an otherwise qualified individual with a disability or any individual by reason of race, color, religion, sex, age, or national origin, is prohibited. Efforts will be made in recruitment and employment to ensure equal opportunity in employment for all qualified persons.