ABOUT RCSD: The Rochester City School District (RCSD), located in vibrant Monroe County on the beautiful shores of Lake Ontario serves over 26,000 students, of whom more than 85% are students of color, in 46 schools and 10 alternative programs. The RCSD Board of Education and Superintendent believe that each student has recognizable and untapped potential that we all strive to discover and fulfill. In a partnership of family, school and community, our mission is to provide all students equitable access to a high quality education and graduate students who are prepared to become productive members of society. The Rochester City School District’s vision is to provide a high quality education that fosters the development of the individual talents and abilities of our students in a nurturing environment of equity. Students are our first priority and will drive each decision. Our work is centered in respect, trust, integrity and accountability.
DISTINGUISHING FEATURES OF THE CLASS: This is a technical position in a school district responsible for supporting the Medicaid compliance and reimbursement operation and services. Duties involve the review and audit of eligible services, and documentation of service delivery. The employee reports directly to, and works under the general supervision of, a higher level staff member. Supervision is not a responsibility of this position. Does related work as needed.
TYPICAL WORK ACTIVITIES: (All need not be performed in a given position. Other activities may be performed although not listed.)
Reviews and audits Medicaid eligible services for the district and outside agencies for compliance with State and Federal guidelines, regulations, and laws;
Reviews documentation of service deliveries to support claims for Medicaid reimbursements;
Reviews quarterly progress reports, assessments, contact logs, statements of accessibility, prescriptions, orders, and referrals;
Develops and maintains the district’s Medicaid intranet site for use as a resource and hub for documents, forms, training materials, information, and announcements;
Assists in the development of procedure manuals and training for the district’s outside agencies;
Maintains supporting documentation for all claims submitted for Medicaid reimbursement in compliance with all State and Federal guidelines, regulations, and laws;
Develops and maintains multiple databases necessary to insure compliance with State and Federal Medicaid guidelines, this includes Medicaid consent, related services attendance, quarterly progress notes, Medicaid eligible students, demographics, and un-billable students;
Submits documentation, and reviews audit defensible claims for Medicaid reimbursement;
Submits claims for Medicaid reimbursement using New York State’s software system.
FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS: Good knowledge of Medicaid eligible services regarding compliance with State and Federal guidelines, regulations, and laws; good knowledge of applicable laws, rules and regulations; good knowledge of employer’s policies relating to Medicaid reimbursement; ability to organize information into reports; ability to review claims, reimbursements, and reports; ability to monitor related services provided; ability to determine if billing is complete and accurate; ability to develop and maintain an intranet site; ability to assist in the development of procedure manuals and training; ability to maintain documentation for Medicaid claims and reimbursement; ability to develop and maintain databases; ability to establish and maintain effective working relationships; ability to communicate effectively both orally and in writing; analytical ability; good judgment; physical condition commensurate with the demands of the position.
MINIMUM QUALIFICATIONS: Graduation from high school or possession of an equivalency diploma, plus EITHER:
(A) Graduation from a regionally accredited or New York State registered college or university with an Associate’s degree in Accounting, Finance, Business Administration, or Business Management, plus one (1) year of paid full-time or its part-time equivalent experience in the review and submission of Medicaid reimbursement forms, or insurance or medical claims; OR,
(B) (3) years of paid full-time or its part-time equivalent experience as defined in (A) above; OR,
(C) An equivalent combination of education and experience as described by the limits of (A) and (B) above.