Supervisor of Medicaid Compliance and Accountability

Berkeley County Schools•Martinsburg, WV

9h•Onsite

About The Position

The Supervisor of Medicaid Compliance and Accountability serves as Berkeley County Schools’ Medicaid Manager and primary district contact for the school-based Medicaid program. The supervisor provides district-wide leadership for Medicaid participation, compliance, documentation, billing, training, data integrity, service delivery, fiscal accountability, internal auditing, and continuous improvement. The supervisor chairs the district Medicaid Team and coordinates representatives from Speech-Language Pathology, Physical Therapy, Occupational Therapy, School Psychology, Nursing, Transportation, Pre-K, EPIC/ E School Docs , Finance, and other appropriate departments . The team supports the implementation and monitoring of the district’s Medicaid procedures, participation requirements, training, service delivery, documentation, billing, and compliance activities. The supervisor also serves as the central point of communication for school-based Medicaid contacts and works with schools, departments, providers, administrators, and external agencies to maintain compliance, increase participation, improve service delivery, and maximize allowable Medicaid reimbursement.

Requirements

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.

Nice To Haves

A master’s degree in Special Education , Educational Leadership, School Administration, Healthcare Administration, Nursing, or a related field is preferred.
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 is preferred.

Responsibilities

Serve as Berkeley County Schools’ Medicaid Manager, primary district Medicaid contact, and central point of communication for schools, departments, providers, administrators, and external agencies.
Chair and facilitate monthly meetings of the district Medicaid Team.
Coordinate team representatives from Speech-Language Pathology, Physical Therapy, Occupational Therapy, School Psychology, Nursing, Transportation, Pre-K, EPIC/ E School Docs, Finance, and other departments as appropriate.
Lead the Medicaid Team to review participation rates, services provided, billing trends, training needs, regulatory updates, compliance concerns, audit findings, and departmental issues.
Coordinate the specialized input of team members regarding related services, transportation, RMTS, Targeted Case Management, coding, data systems, finance, and billing.
Communicate the purpose, requirements, and value of school-based Medicaid and reinforce district expectations for eligible staff and departmental participation.
Provide district-wide oversight of Medicaid participation, service delivery, documentation, billing, reimbursement, and compliance activities.
Develop, implement, monitor, and update district Medicaid procedures, manuals, handbooks, forms, compliance flowcharts, and operational guidance.
Ensure compliance with applicable federal and state Medicaid requirements, IDEA, West Virginia Department of Education requirements, and Berkeley County Schools policies.
Conduct internal audits and compliance reviews of provider records, service logs, billing practices, student records, transportation documentation, and supporting records.
Develop and implement an annual Medicaid audit schedule for schools, departments, providers, transportation services, and billing records.
Coordinate responses to external audits, monitoring visits, program reviews, and requests for documentation.
Develop and monitor corrective action plans and implement recommendations resulting from audits, reviews, consultants, or identified deficiencies.
Ensure Medicaid providers maintain required licenses, certifications, qualifications, credentials, and enrollment status.
Establish procedures to ensure accurate and consistent student, provider, consent, service, participation, and billing data across district systems.
Use information from WVEIS, E-School Docs, EPIC, E Schools Docs , Medicaid billing systems, and other approved systems to monitor participation, service delivery, documentation, and billing.
Collect, verify, and report monthly student, provider, caseload, consent, participation, service-delivery, and billing data from schools and departments.
Monitor RMTS participation, response timelines, follow-up requirements, and compliance with state deadlines.
Monitor Targeted Case Management for participation, documentation, service delivery, and billing opportunities.
Develop dashboards and performance indicators to monitor participation rates, reimbursement, documentation compliance, claim denials, rejected claims, and missed billing opportunities.
Identify significant increases or decreases in billing and participation by school, department, service area, and transportation program and recommend corrective or improvement actions.
Provide monthly Medicaid reports to the Superintendent, Chief Financial Officer, and Executive Director of Special Education, including reimbursement generated, participation rates, billing trends, compliance concerns, corrective actions, and program successes.
Review provider schedules, caseloads, workload assignments, and service-delivery records to support IEP compliance, equitable staffing, efficient use of personnel, and timely services.
Develop and monitor procedures for obtaining, tracking, maintaining, and uploading Medicaid parent consent documentation.
Develop procedures for identifying and addressing missed services, incomplete documentation, scheduling concerns, and service-delivery issues.
Monitor district-wide implementation of Medicaid-eligible services, including related services, nursing, psychology, audiology, transportation, and other approved services.
Coordinate with Transportation and Special Education to monitor Medicaid-eligible transportation services, required documentation, van billing procedures, and reimbursement opportunities.
Collaborate with administrators, coordinators, supervisors, and providers to resolve service-delivery, documentation, staffing, and compliance concerns.
Assist with recommendations and oversight related to contracted providers and outside agencies delivering special education or related services.
Develop and provide ongoing professional development, in-service training, written guidance, examples, and technical assistance related to Medicaid participation, documentation, billing, service delivery, and compliance.
Establish, train, and support a Medicaid contact at each school.
Serve as the key district contact for school-based Medicaid contacts and maintain a consistent communication and follow-up structure between schools and the central office.
Communicate changes in Medicaid regulations, billing requirements, documentation standards, state guidance, and district procedures to affected personnel.
Collaborate with Finance and billing personnel to ensure timely, accurate, complete, and compliant submission of Medicaid claims and resolution of denied or rejected claims.
Analyze reimbursement and participation trends, identify missed billing opportunities, forecast Medicaid revenue, and recommend strategies to maximize allowable reimbursement while maintaining compliance.
Stay current on Medicaid requirements, maintain confidentiality and organized records, support continuous improvement initiatives, and perform other duties assigned by the Executive Director of Special Education.