Medicaid Systems Specialist (One Year Only)

Performs a variety of professional and technical tasks to support the Fairfax County Public Schools Medicaid Reimbursement Program; utilizes Medicaid documentation and billing software application (FCPSMED) along with other computer applications to ensure Medicare reimbursable services are verified for eligibility, appropriately recorded, and submitted for reimbursement; develops reporting to reconcile payments and audit database information for accuracy; provides professional development to end users on systems functionality and Medicaid state and federal billing requirements.

This job operates in a professional office environment and has a noise level of mostly low to moderate. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.

• Medicaid or other health insurance billing experience.

1. Provides for all system facets of the FCPSMED application and its interface with other computer applications required to support the Medicaid program.
2. Manages data; develops complex reports and ad hoc data queries.
3. Develops functional system requirements and performs acceptance testing for all FCPSMED upgrades and updates.
4. Reviews nightly data uploads and ensures the quality of data and data transfers are accurate and complete.
5. Oversees and maintains a support (help) desk for FCPSMED users such as speech and language pathologists, occupational therapists, physical therapists, audiologists, school social workers, and school psychologists; maintains user accounts and security.
6. Provides both formal and ad hoc professional development to end users.
7. Submits and reconciles Medicaid payments; audits data and resolves discrepancies.
8. Performs quality review of health-related student information and documentation.
9. Verifies Medicaid eligibility status of students.
10. Analyzes and monitors student health-related treatment plans, student health-related service logs, student educational records such as individualized education plans, 504 plans, and all student documentation related to Medicaid claim submissions to ensure compliance with state and federal Medicaid billing guidelines.
11. Confirms state licensure status of therapists and clinicians providing Medicaid services and ensures compliance with billing requirements.
12. May act as a liaison for internal technology activities.
13. Responds to internal and external requests related to the Medicaid program.
14. Performs related duties as required or assigned.