Compliance Medicaid Coordinator

Job Title:         Compliance/Medicaid Coordinator- PDF Download

Department: Clinical

Reports To:    Program Director

FLSA Status:   Full Time Exempt 

SUMMARY

The Compliance/Medicaid Coordinator (CMC) develops and oversees control systems to prevent or deal with violations of legal guidelines and internal policies, evaluates the efficiency of controls and improves them continuously, and revises procedures, reports etc. periodically to identify hidden risks or non-conformity issues. The CMS is also responsible for Medicaid intake, billing and reporting to the Director of Finance.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Other duties may be assigned as necessary
  • Responsible for submitting claims to Medicaid
  • Maintains security and confidentiality of files at all times
  • Monthly audits of client and staff files to ensure compliance
  • Data entry, data retrieval and reporting in KaleidaCare
  • Generate monthly Medicaid and Compliance report to submit to the Leadership Team
  • Reports any/all suspecting abuse or neglect to the Administrator on duty and they immediately report the information to DFPS- txabusehotline.org or 1-800-252-5400.
  • Demonstrate responsibility, maturity and role modeling in all interactions with foster parents, staff and children.
  • Comfortable being a member of a team but also working alone when necessary
  • Follow Hope Rising policies as well as RCCL Minimum Standards and RCC Contract Standards, at all times.

 

Supervisory Responsibilities

May supervise admin at some point

Qualifications

  • Proven experience as compliance manager
  • Resourceful and organized
  • In-depth knowledge of the industry’s standards and regulations
  • Excellent knowledge of reporting procedures and record keeping
  • An analytical mind able to “see” the complexities of procedures and regulations
  • Excellent communication skills
  • BSc/BA in law, finance, business administration or nursing/psychology/social services field
  • 3-4 years experience in billing coordination

Language Skills

Ability to read and comprehend simple instructions, short correspondence, and memos.  Ability to communicate effectively both verbally and in writing with superiors, colleagues, and individuals inside and outside the ministry.

Mathematical Skills

Ability to apply basic mathematical concepts such as fractions, percentages, ratios, and proportions to practical solutions.

Reasoning Ability

Ability to apply common sense understanding to carry out simple one or two-step instructions. Ability to deal with standardized situations with occasional variables.

Other Requirements

Valid driver’s license, appropriate insurance and reliable car.

Must submit to and pass a pre-employment drug test.

Must submit to and pass random drug tests during employment.

Must successfully pass all background screens as required by the state.

Must pass at TB test.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to have good use of hands and fingers for typing and lifting.  The employee will be required to have repetitive use of their feet and hands.   Specific vision abilities required by this job include close vision, depth perception and ability to adjust focus. 

Other physical requirements specific to this job:

  • Occasionally required to lift/carry up to 50 lbs.
  • Occasionally required to push/pull up to 50 lbs.
  • Occasionally required to climb stairs
  • Occasionally required to bend and/or stoop
  • Occasionally required to kneel and/or crouch

Key:   Constantly: (67-100%) 6-8 hours      Frequently: (34-66%) 4-6 hours      Occasionally: (0-33%) 1-3 hours

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

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