Medicaid Specialist

WAGE: $25.17 - $30.11 per hour IMMEDIATE SUPERVISOR: Director of Student Health Services OPEN: Until Filled General Summary Wallowa County Education Service District is seeking a Medicaid Specialist with Medicaid Administrative Claiming (MAC) and Fee-For-Service billing experience. The MAC program provides a way of reimbursing districts for claimable work already being performed by staff members in the schools. The MAC Specialist is responsible for providing live professional development training to local school district staff including building and district administrators, educators, and office personnel. The MAC Specialist works in collaboration with WESD and school district business managers and Oregon Department of Human Services. Locally, the MAC Specialist collects, compiles, and tracks data submissions in real time per state and federal guidelines. Concise and timely written and oral communication is essential to this position as are attention to detail and timelines. The successful candidate should enjoy working with people as much as they do with data. Position Goal Provide oversight for the implementation and operations of Medicaid administrative claiming (MAC) and fee‑for‑service billing to ensure that Medicaid policy decisions and procedures are implemented appropriately. Essential Functions In collaboration with WCESD business manager, maintain MAC intergovernmental agreements with the Department of Human Services (DHS) and sub‑agreements with local districts and partners. Act as a conduit between DHS and local operations regarding MAC policy and program information, requests for information, frequently asked questions, and inquiries of state or federal guidance. Provide timely information to subcontractors regarding MAC training, survey process, cost pool, and claiming procedures. 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. Assist MAC sub‑contractors in complying with state and federal guidelines in all MAC applications (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. Coordinate with the ESD business office on eligibility, claiming and reimbursement procedures of Medicaid fee‑for‑service billing. 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. Perform job‑related tasks as designated by supervisor. Establish and maintain cooperative work relationships with WESD employees and local education agency representatives. Travel may be required to attend trainings or present a training. Minimum Prerequisites Experience with Medicaid billing / MAC Survey. Competence in effective group training, oral and written communication skills, implementing training and documentation systems, and coordinating multi‑agency projects. Proficient in word processing and spreadsheet applications. Previous successful experience in education or health and human services positions preferred. Wallowa County ESD reserves the right to reject any or all applications and to not fill the position or to post it again. #J-18808-Ljbffr