Accounting Specialist – Medicaid Billing

Purpose: The Accounting Specialist – Medicaid Billing is responsible for the accurate, timely, and compliant billing of school-based Medicaid services and for the financial tracking, analysis, and reporting of all district Medicaid revenue. This position reviews and assists schools and service providers with Medicaid documentation and billing, monitors Medicaid revenue against budget and prior years, and serves as the liaison between the Finance Department, the Office of Special Services, Schools, service providers, and the South Carolina Department of Education (SCDE) Office of Medicaid Services.

Reports to: Senior Executive Director of Finance

Terms of Employment: 240 contract days per year, 8 hours per day, Exempt Position

Salary: FMSD (S2) Support Salary Schedule

Job Responsibilities:
• Manage the District’s school-based Medicaid billing process in accordance with the current SCDHHS Local Education Agencies (LEA) Services Provider Manual, Medicaid bulletins, and applicable fee schedules, including Rehabilitative Behavioral Health Services (RBHS), Special Needs Transportation (SNT), Autism Spectrum Disorder (ASD) services, and services delivered via telehealth.

Review and assist schools with billing by verifying that services are supported by required documentation before claim submission (e.g., IEP/IFSP or treatment plan, required referrals or authorizations, service logs, signature sheets, and progress summaries completed at least every 90 days).
• Verify student Medicaid eligibility, MCO enrollment, and third-party liability (TPL) before billing, and confirm that required parental consent and annual written notification under IDEA (34 CFR §300.154) are on file.
• Submit, track, and reconcile Medicaid claims; research and resolve denials, rejections, and adjustments; and resubmit corrected claims within timely filing limits.
• Reconcile Medicaid remittance advices and deposits to claims submitted, prepare journal entries, and ensure Medicaid revenue is accurately recorded in the district’s financial system.
• Coordinate the district’s participation in the School District Administrative Claiming (SDAC) program, including maintaining participant rosters, monitoring time study compliance, and supporting quarterly claim preparation.
• Work with district-employed and contracted service providers (e.g., speech-language pathologists, occupational and physical therapists, nurses, psychologists, behavioral health providers) to ensure timely and complete documentation and billing.
• Maintain a current roster of rendering providers, including licensure, credentials, NPI numbers, and Medicaid enrollment status, and ensure contracted providers and billing vendors meet SCDHHS subcontract requirements.
• Review contracted service provider and billing vendor invoices against services delivered and contract terms; track contracted services costs.
• Prepare monthly budget-to-actual reports for Medicaid revenue and related expenditures by program, service type, and school, including year-end projections.
• Prepare comparative analysis to prior years, including revenue, claim volume, units billed, denial rates, Medicaid-eligible student counts, and revenue by provider and school, and identify trends, variances, and opportunities.
• Provide periodic summary and overview analysis to the Finance and Special Services Departments to support budgeting, staffing, and program decisions.
• Monitor changes in federal and state Medicaid policy, including SCDHHS manual updates, CMS school-based services guidance, and Medicaid eligibility changes under federal H.R. 1 (2025) that may affect student enrollment and district revenue; assess and report the financial impact.
• Maintain Medicaid billing and supporting records in accordance with SCDHHS record-retention requirements, and keep all student and health-related information confidential in accordance with FERPA, HIPAA, and Board policy.
• Participate in SCDE Office of Medicaid Services, SCDHHS, and MCO trainings and meetings to remain current on Medicaid requirements.
• Remain technically current and competent by learning new technologies and/or software as required by the position.
• Other duties as assigned by Supervisor.

Qualifications:
• Associate degree in accounting, finance, business, or healthcare administration required; bachelor’s degree preferred.
• Minimum of five years of experience in accounting, medical billing, or Medicaid/insurance claims processing.
• Working knowledge of Medicaid billing practices, including CPT/HCPCS procedure codes, NPI, eligibility verification, remittance advice, and claim denials and appeals preferred.
• Working knowledge of confidentiality requirements under FERPA and HIPAA.
• Demonstrated knowledge, skill, and experience with the use of computers and related technology (use of e-mail, networks, and Microsoft Office or Google Suite), including advanced Excel skills (pivot tables, lookups, and data analysis).
• Strong analytical skills with the ability to compile, analyze, and present financial data clearly and accurately.
• Effectively communicate with district staff, service providers, state agencies, and vendors.
• Must possess strong organizational, problem-solving, interpersonal, and communication skills in both written and oral formats.
• Exhibit a high level of professionalism with the ability to handle confidential information and use good judgment.
• Ability to work well under deadlines and with minimal supervision.

Evaluation: Performance will be evaluated annually in accordance with the provisions of the Board’s policy on evaluation of non-certified personnel.