Supervisor of Medicaid Compliance and Accountability
On-siteMartinsburg, West Virginia, United States
Job Summary
Lead the district Medicaid Team to chair monthly meetings, coordinate representatives from Speech-Language Pathology, Physical Therapy, Occupational Therapy, and other departments, and facilitate reviews of participation rates, billing trends, and audit findings. Provide district-wide oversight of Medicaid participation, compliance, documentation, and billing by developing procedures, conducting internal audits, and coordinating responses to external reviews. Establish school-based Medicaid contacts, train staff on regulations and documentation standards, and monitor service delivery for related services, nursing, and transportation. Analyze reimbursement data to identify missed billing opportunities, develop performance dashboards, and submit monthly reports to the Superintendent and CFO. Maximize allowable Medicaid reimbursement while ensuring strict adherence to IDEA, federal, and state requirements.
Required Qualifications
- Demonstrated knowledge of the Individuals with Disabilities Education Act, school-based Medicaid, related services, documentation, billing, reimbursement, and regulatory compliance
- Demonstrated ability to analyze data, conduct compliance reviews, develop procedures, identify trends, and implement continuous improvement strategies
- Strong leadership, organizational, communication, training, problem-solving, and interpersonal skills
- Ability to work collaboratively with district personnel, families, healthcare providers, consultants, and external agencies
- Ability to maintain confidentiality and exercise sound professional judgment when handling protected student, personnel, medical, and financial information
- Knowledge Of Federal and state Medicaid requirements applicable to school-based services
- Knowledge Of Individualized Education Programs, related services, procedural safeguards, and IDEA requirements
- Knowledge Of Medicaid documentation, billing, reimbursement, auditing, monitoring, and corrective action processes
- Knowledge Of Medicaid-eligible services, including related services, nursing, transportation, Targeted Case Management, and other approved services
- Knowledge Of Random Moment Time Study requirements and procedures
- Knowledge Of WVEIS, E-School Docs, EPIC, and other district-approved Medicaid and special education systems
- Knowledge Of Provider licensure, certification, qualification, and enrollment requirements
- Knowledge Of FERPA, HIPAA, Medicaid confidentiality requirements, and Berkeley County Schools policies
Desired Qualifications
- A master's degree in Special Education, Educational Leadership, School Administration, Healthcare Administration, Nursing, or a related field
- A minimum of three years of successful experience in special education, related services, school-based Medicaid, educational administration, healthcare administration, finance, auditing, or regulatory compliance
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