An Eligibility Specialist provides assistance and information for people who apply for a government benefits program or health care program. Answers questions, assists with an application process, and reviews applications and relevant background information to determine eligibility. May assist eligible applicants with enrolling in a program.
To perform the Technical Operations of the Medicaid School-Based Services (MSBS). The Medicaid Compliance Specialist
will provide quality control and assurance of all internal and external data and processes related to Medicaid billing. Acting as a subject matter expert, the Compliance Specialist will routinely audit, monitor, and investigate Medicaid claims for applicable IEP services to include the expansion of Free Care services (IHP/504/BIP/Other).
ESSENTIAL FUNCTIONS
ESSENTIAL
FUNCTIONS
Incumbent must achieve the following outcomes with or without reasonable accommodation: Provides quality control and assurance of all internal and external data and processes related to Medicaid billing to assure full compliance with current District, State, and Federal laws.
Utilizes and manages internal and external data related to Medicaid billing for applicable IEP services and for the expansion of Free Care services to include IHP/504/BIP/Other, including preparation and analysis of regular monthly reports.
Trains on billing system and other data management and software-related issues.
Working knowledge of ICD-10 diagnosis codes.
Working knowledge of CPT procedure billing codes.
Oversees data entry, monitoring accuracy and completion.
Monitoring of provider documentation for accuracy and completion.
Monitors the timely filing of claims.
Consults and assists providers on technical issues.
Communicates with the Human Services Department, Medical Assistance Division and State Department of Education.
Processes physician referrals for billable services.
Verification of Medicaid eligibility.
Researches outside resources to obtain up-to-date Primary Care Provider (PCP) data.
Maintains database to ensure all information impacting billing is current and accurate.
Maintains files and assists in preparations for site visits and external audits.
Consults and assists with appropriate outside agencies on technical issues.
Consults and networks with other school districts in New Mexico.
Conducts presentations on MSBS in APS as required.
Develops and maintains public relations contacts with Primary Care Providers and other medical personnel.
Maintains
PE/MOSAA
potential Medicaid eligible students in billing system.
Investigates possible errors, problems and/or discrepancies with the IEPs and Medicaid claims.
Monitors the timely filing of the administrative time-study.
Provides technical support for compiling of administrative time study data.
Provides technical support to MSBS unit.
DUTIES:
In addition to the essential functions of this job, the incumbent must perform the following duties: Complies with state-approved Code of Ethics of the Education Profession and upholds and enforces rules, administrative directives and regulations, school board policies, and local, state and federal regulations.
Articulates and facilitates the implementation of the mission and values of the Albuquerque Public Schools.
Safeguards confidentiality of privileged information.
Prepares and maintains accurate and complete records and reports as required by law, state directives, District policy and administrative regulations.
s the responsibility for the supervision and care of District inventory, proper and safe use of facilities, equipment and supplies, and reports safety hazards promptly.
Maintains professional relationships and works cooperatively with employees, the community and other professionals.
Maintains professional competence through individual and staff training, in-service educational activities and self-selected professional growth activities.
Attends and/or conducts staff meetings and participates on committees within area of responsibility.
Performs other tasks related to area of responsibilities as requested or assigned by an immediate supervisor.
PREFERRED KNOWLEDGE, SKILLS, ABILITIES AND EXPERIENCE
PREFERRED
KNOWLEDGE, SKILLS, ABILITIES, EXPERIENCE AND EDUCATION
Effective communication skills, both verbal and written.
Flexibility, organization, decision-making and problem solving skills.
Interpersonal skills with diverse populations in-person and on the telephone.
Ability to meet deadlines, work on multiple projects and coordinate the work of others.
Knowledge of word processing, database and spreadsheet software.
Bookkeeping skills.
Knowledge of Medicaid Federal and State regulations procedures and laws.
Knowledge of State Medical Assistance Division and Medicaid Reimbursement in schools.
Knowledge of billing fiscal agent.
Knowledge of Special Education functioning in schools.
Ability to present ideas and plans, apply research techniques and remediate problems for forecast needs.
Ability to assess, plan, intervene and re-evaluate the Program.
Associate's Degree.
REQUIREMENTS
MINIMUM
REQUIRED EDUCATION, LICENSES, CERTIFICATIONS, EXPERIENCE AND SKILLS
Associates Degree and three years of Medical billing experience.
OR High School Diploma or GED and six years of Medical billing experience.
Knowledge of ICD-10 coding
