POSITION SUMMARY:

Under the direction of the Manager or designee, the Associate Medicaid Analyst performs complex and varied financial, administrative, and customer service functions in support of department specific projects, which may include RMTS coding or time study projects. The Associate Medicaid Analyst is also responsible for School-based Medicaid claiming processes and general operations, which require a high degree of independent action and the setting of priorities and procedures for accomplishing tasks. This position will also participate as a member of multiple project teams.

ESSENTIAL FUNCTIONS:

• Perform all activities related to the initial review of time study related data, including prioritization and directing the information to the appropriate Operations Coordinator
• Perform billing, claim generation and claim reconciliation to ensure high quality, effective, efficient and valid billing and claiming outcomes
• Make complex decisions regarding the correct application of client-specific rules and requirements pertaining to the administration of time studies and/or the submission and processing of Medicaid claims
• Notify senior staff of discrepancies and recommend action steps on a timely basis and assist in the preparation of needed summary reports
• Identify, review and analyze discrepancies and/or provide data and prepare documentation to ensure accurate claiming
• Develop and maintain spreadsheets, databases and/or systems to track and monitor relevant claims data and time study data
• Assist in the gathering of data and information in order to prepare ad hoc and other reports. Also maintain all forms of claim and volume data used for tracking and reporting
• Independently implement and manage tasks in accordance with departmental objectives, including developing and maintaining project plans and time schedules, and reviewing pertinent correspondence, communications and other background materials on a timely basis to ensure that projects and operations remain on track
• Act as point of contact for customer inquiries and issues
• Perform other duties as directed, including participating as a member of project and claiming teams
• Perform other duties as required.

REQUIRED QUALIFICATIONS:

• Bachelor’s degree in Business Administration, Accounting, Finance, or equivalent  
• 1-3 years of relevant experience
• Demonstrated ability to review, research, assess and interpret healthcare billing and claiming information Ability to design and program spreadsheets, databases, or custom reports
• Proficiency with Microsoft Office or similar software, specifically Outlook, Word, Excel, Powerpoint and Access.
• Excellent interpersonal, verbal and writing skills needed to present or communicate effectively with all levels of management
• Must possess strong organizational skills, the ability to establish priorities, and resolve problems independently
• Ability to maintain complex records and prepare periodic complex financial reports
• Demonstrates investigation skills and initiative, judgment and discretion

About School Based Claiming (SBC)

Federal financial participation (FFP) is available through Title XIX and Title XXI of the Social Security Act to match expenditures by cities and towns, regional school districts and charter schools (collectively, Local Education Agencies (LEAs)) for the provision of medically necessary medical services provided to Medicaid-enrolled students.  Also eligible for FFP are the LEA costs associated with performing Medicaid administrative activities related to the delivery of services and with performing qualifying outreach activities.  Collectively, this program is referred to as the School-Based Medicaid Program.

The SBC unit at HCFS works closely with Massachusetts and other states to develop, implement, and manage various activities that support direct service or administrative activity claiming to the Medicaid program.  To that end, SBC develops, maintains, and supports solutions for states to compile, report and review eligible expenditures for Medicaid Administrative Claiming, Direct Service Cost Report Reconciliation and Settlement, Medicaid Eligibility Matching, Random Moment Time Studies or other equivalent allocation methods to support the identification of Medicaid related costs. With a deep knowledge of federal Medicaid regulations, SBC optimizes opportunities, while ensuring compliance with all applicable state and federal rules.   Today, SBC supports over 50,000 users in 9 states for school-based other social service agency Medicaid FFP claiming programs.