Account Specialist Senior - Medicaid

CATEGORY: Classified
TITLE: Account Specialist Sr. – Special Education - Medicaid

JOB DESCRIPTION:

Coordinate, and implement the School-Based Medicaid Program in accordance with all applicable federal and state Medicaid laws.

QUALIFICATIONS:

• Education and/or experience equivalent to a High School Diploma or GED
• Three (3) years administrative support experience, preferably in a human resources department
• State of Arizona Identity Verified (IVP) Fingerprint Clearance Card
• May require a valid Arizona Driver's License

ESSENTIAL FUNCTIONS:
(Essential functions, as defined under the Americans with Disabilities Act, may include any of the following tasks, knowledge, skills, and other characteristics. This list is ILLUSTRATIVE ONLY, and is not a comprehensive listing of all duties and responsibilities performed by incumbents of this class.)

DUTIES AND RESPONSIBILITIES:

Program coordination and compliance

• Serve as the district's liaison to AHCCCS and its third-party administrator for the Medicaid in Public Schools (MIPS) program.
• Monitor state and federal Medicaid rules, attend required meetings, and update district procedures to stay compliant.
• Track licensure and credentials of school health providers to confirm billing eligibility.
• Gather and analyze program data to solve problems, and coordinate with other districts to improve compliance and reimbursement.

Random moment time study and data systems

• Coordinate the random moment time study (RMTS), including monitoring response rates and following up on missed moments.
• Maintain Medicaid-related data in the student information system and state databases.
• Work with district departments to gather information needed for state and federal reporting.

Student eligibility and consent

• Identify Medicaid-eligible students each month and share current eligibility with providers and special education teachers.
• Collect and track the parental consent required under IDEA before billing, along with annual notifications.
• Protect student health and education records under FERPA, HIPAA, and state and federal rules.

Documentation review and claims

• Review service documentation for compliance before billing submission, including personal care, nursing, and specialized transportation.
• Maintain a database tracking providers, students, and billable services.
• Work with special education administrators and case managers for IEP documentation related to Medicaid claiming.

Staff training and support

• Train special education providers and other staff on documentation standards, billing procedures, and RMTS responses.
• Develop and update training materials, guides, and forms.
• Give Medicaid updates and technical assistance at special education provider and nurse meetings.

Quarterly claiming and reporting

• Prepare quarterly RMTS participant rosters for direct service and administrative claiming.
• Prepare, submit, and reconcile quarterly reports as required by AHCCCS.
• Review provider billing reports from the third-party administrator for compliance.

Annual reconciliation and compliance reviews

• Prepare and submit the annual cost reconciliation and required state reports.
• Establish checks to ensure data integrity.
• Participate in AHCCCS or third-party administrator compliance reviews and audits.

Other duties

• Perform other job-related duties as assigned.

KNOWLEDGE, SKILLS AND OTHER CHARACTERISTICS:

• Knowledge of multi-line telephone systems.
• Knowledge of customer service/public relations practices and procedures.
• Knowledge of principles, practices and standards of human resource administration in assigned areas.
• Knowledge of teacher certifications and highly qualified requirements.
• Knowledge of appropriate district policies and procedures related to the assigned
• Knowledge of applicable state and federal statutes, regulations and laws governing Special Education and Medicaid Billing
• Knowledge of computer software utilized in tracking and maintaining reports and accounts
• Knowledge of customer service/public relations practices and procedures
• Knowledge of recordkeeping/file management practices and procedures
• Knowledge of Microsoft Office and Google Drive Applications
• Skill in problem analysis and resolution.
• Skill verifying applicant information and completing background investigations.
• Skill providing information in a clear and concise manner.
• Skill utilizing, maintaining and updating computer software databases.
• Skill establishing and maintaining effective working relationships.
• Skill accurately inputting and retrieving information from computer databases
• Skill utilizing verbal and written communication in the development of reports and records
• Skill implementing policies and procedures related to area of assignment
• Skill utilizing customer service/public relations techniques when responding to inquiries and complaints
• Skill establishing and maintaining effective working relationships
• Skill in, but not limited to:
• Email
• Word Processing
• Spreadsheets
• Databases
• Presentation Software
• Accounting and basic math
• Use of standard office equipment
• Ability to effectively communicate with others.
• Ability to maintain confidential information.
• Ability to work independently in absence of supervision.

WORKING CONDITIONS:

General Office environment

PHYSICAL EFFORT:

Position may require climbing, stooping, standing, walking, lifting, keyboarding, talking, listening, eye strain and repetitive motions.

May be required to travel to in and out-of-district sites.

May require lifting and carrying materials and supplies weighing up to 35 pounds

WORK YEAR: 12 months
DEPARTMENT/SCHOOL: Special Education Department
GRADE: 49
REPORTS TO: Director of Special Education
EVALUATION: Classified Personnel Evaluation
SUPERVISES: N/A
PREPARED: January 2004
REVISED: September 2026