*Pending CSEA Approval

POSITION(S): School Health Billing and Reimbursement Coordinator

Purpose 

The job of School Health Billing and Reimbursement Coordinator is to oversee and manage all aspects of school health billing and reimbursement for the Shasta County Office of Education (COE), Local Educational Agencies (LEAs), and community-based partners. This role ensures compliance with MediCal billing requirements, including the Local Educational Agency Billing Option Program (LEABOP), School MediCal Administrative Activities (SMAA), the Fee Schedule, and others as they arise. The Coordinator collaborates with various internal and external partners to maximize federal reimbursements while providing technical assistance to enhance the sustainability of school health initiatives.

This job reports to the Assigned Administrator/Supervisor.

Essential Functions

?       Oversee the entire billing cycle for school health services within the County Office of Education, ensuring timely, accurate, and compliant claims submission, payment processing, and reconciliation of accounts. This includes managing billing operations for the COE as it bills for its own services while preparing for possible consortium billing arrangements. In addition, provide technical assistance and support to partner organizations, particularly Local Educational Agencies (LEAs), to enhance their billing capabilities and ensure they can effectively navigate the complexities of claims management.

?       Enter, verify, and audit billing information while maintaining comprehensive records of all claims submitted, payments received, and outstanding accounts. To accomplish these tasks effectively, collaboration with internal business departments, including fiscal and human resources, will be required.

?       Develop, implement, and enforce comprehensive policies and procedures that comply with billing regulations. Recognize that many of our processes will be new and require careful development to ensure they meet state and federal guidelines. Establish a framework for maintaining and updating these processes as regulations change, ensuring that all practices remain compliant and effective.

?       Regular assessments of billing practices should be conducted to verify adherence to established guidelines. Stay informed about changes in legislation and funding mechanisms affecting school health services, adapting policies accordingly to reflect these updates.

?       Design and deliver a comprehensive training program on billing processes, program requirements, and effective claims management practices tailored for COE staff, LEAs, and community partners. Collaborate with expert consultants, third-party billing vendors, and partner organizations to utilize their training and co-create training, ensuring that they address all partners' diverse needs in the billing process. This includes engaging with providers who will bill for services, supervisors, and other staff supporting billing activities.

?       Provide ongoing technical assistance to stakeholders to ensure the successful implementation of school health billing programs. Foster a culture of continuous learning by regularly updating training materials to reflect current regulations and best practices. Utilize feedback from training sessions to refine programs and improve the overall effectiveness of billing operations.

?       Analyze billing data to identify trends, assess program effectiveness, and recommend improvements to enhance revenue generation and service delivery while ensuring compliance with data privacy regulations. Maintain a thorough understanding of FERPA (Family Educational Rights and Privacy Act) and HIPAA (Health Insurance Portability and Accountability Act) requirements to safeguard sensitive student information. Prepare and maintain appropriate records of consent and other student data, ensuring that all documentation complies with legal standards.

?       Utilize Electronic Health Records (EHR) and other data management tools to ensure the accuracy and integrity of billing data. Create and maintain systems to facilitate efficient data entry, tracking, and reporting, enabling timely access to critical information. Generate comprehensive reports detailing billing activities, revenue generated, and compliance metrics, presenting insights that support informed decision-making and the continuous improvement of services.

?       Foster and maintain strong relationships with Managed Care Plans, the Department of Health Care Services, LEAs, community-based organizations, and other key agencies to ensure seamless billing and reimbursement processes that benefit students and their families. Work collaboratively with partners to bill for integrated health services, ensuring that available services and supports are maintained. Actively engage with Local Educational Agencies to provide intensive support and technical assistance in billing practices, promoting the sustainability and growth of specialized services as needed.

?       Oversee internal and external audits related to billing and reimbursement, ensuring that all necessary documentation is accurate, compliant, and readily available. Manage an organized audit binder that includes all pertinent documents, processes, and protocols required to meet audit requirements consistently. Build and implement robust systems that facilitate regular reviews of billing practices to ensure ongoing compliance with state and federal regulations. Develop and execute corrective action plans based on audit findings to address compliance issues and improve operational practices.

?       Maximize using billing software and data management systems to optimize operational efficiency and accuracy in claims processing. Focus on leveraging current tools to streamline billing workflows and improve documentation and reporting processes. Provide comprehensive training to all billing staff on the effective and efficient use of these technologies, enabling them to perform their tasks more quickly and precisely. Regularly evaluate and refine the use of technology within the billing operations to ensure that it meets the organization's evolving needs, fostering a culture of continuous improvement. Stay informed about emerging technologies that complement existing systems and enhance billing practices.

?       Engage in ongoing professional development by attending relevant meetings, conferences, workshops, and training sessions to stay current with best practices in school health billing and reimbursement. Participate in Communities of Practice and Professional Learning Networks to share insights and strategies with peers. Research best practices to inform program development and enhancement, ensuring that training materials and resources are regularly reviewed and updated to reflect current practices, regulations, and emerging trends and regulations in healthcare funding.

Other Functions

Performs other related duties as assigned for the purpose of ensuring the efficient and effective functioning of the work unit.

Job Requirements: Minimum Qualifications

Skills, Knowledge, and Abilities:

SKILLS are required to perform multiple tasks, and skills need to be upgraded to meet changing job conditions occasionally. Specific skill-based competencies required include: expertise in billing processes, including LEABOP, SMAA, and the Fee Schedule; proficiency in coding systems (CPT, ICD10) and an understanding of billing requirements for public programs and third-party payers; strong analytical and problem-solving skills necessary for evaluating program performance and financial data; excellent organizational skills to manage multiple projects and deadlines; effective written and verbal communication skills for training and stakeholder engagement; high proficiency in billing software, data management systems, and Google tools (Docs, Sheets, Forms) and Microsoft Office (Excel).

KNOWLEDGE is required to understand complex regulations and guidelines related to school health billing, including: comprehensive knowledge of MediCal regulations and compliance requirements; familiarity with school health program elements and funding mechanisms; understanding of financial management principles, including budgeting and forecasting.

ABILITY is required to lead and facilitate effective training sessions for diverse groups of partners; analyze financial and program data to inform decision-making and improve billing processes; establish and maintain effective working relationships with a wide range of internal and external partners; work independently and collaboratively, demonstrating flexibility and adaptability to changing priorities and challenges.

Responsibility

Responsibilities include: working under limited supervision using standardized practices and/or methods; leading, guiding, and/or coordinating others; operating within a defined budget. Utilization of resources from other work units is often required to perform the job's functions. There is a continual opportunity to have some impact on the organization’s services.

Working Environment  

The usual and customary methods of performing the job's functions require the following physical demands: some lifting, carrying, pushing, and/or pulling; some stooping, kneeling, crouching, and/or crawling; and significant fine finger dexterity. Generally, the job requires 80% sitting, 10% walking, and 10% standing. This job is performed in a generally clean and healthy environment.

Experience      Job-related experience is required, with a minimum of two (2) years of experience in Medi-Cal billing, claims submission, or school finance preferred.

Education        Bachelor’s degree in public health, healthcare administration, business administration, finance, accounting, or a related field, or a combination of equivalent experience.

Equivalency    Any combination is equivalent to graduation from high school and relevant work experience in Medi-Cal billing, claims submission, or school finance.

The stated education and experience requirements are the preferred minimum qualifications for this job. However, relevant experience, certificates, and/or licenses may substitute for the education requirement.

FLSA Status                                                    Approval Date                                              Salary Range

Non Exempt                                                                                                                                   37