S27-297 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.

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