Medicaid and Funding Manager

Delaware, County of (OH); Delaware (OH); On-site; USD 85,000 - 110,000; Full time

Job summary

Delaware County Board of Developmental Disabilities (DCBDD) seeks a Medicaid and Funding Manager to lead waiver administration and funding operations. You will supervise Assessment Specialists and Funding Specialists, coordinate with SSA and providers, and ensure compliant processes in PAWS, billing, and enrollments.

You will develop and maintain knowledge of relevant codes, perform fiscal analysis, and report to senior leadership.

Qualifications

• Bachelor’s degree in a related field and five years of Medicaid Waiver experience; Master’s Degree and three years of supervisory experience preferred; an equivalent combination of experience and education sufficient to perform the essential job functions.
• Service and Support Administration Supervisor Certification per OAC 5123-5-02 preferred, or ability to obtain at time of appointment and maintain throughout employment.
• Must possess a valid State of Ohio Driver's License and acceptable driving record as stipulated by the Board’s insurance carrier.

Responsibilities

• Oversees Medicaid waiver administration and local funding operations; ensures accurate and compliant waiver administration and funding utilization.
• Supervises Assessment Specialists and Funding Specialists; provides guidance and corrective actions as needed.
• Liaises with SSA Supervisors, Administrators, and providers to ensure PAWS, billing, enrollments, and redeterminations related to waiver functions.
• Develops knowledge of Ohio Administrative Code, Ohio Revised Code, and waiver amendments.
• Provides fiscal analysis and reports to the Superintendent.
• Manages waiver allocation and budgets in collaboration with senior leadership.
• Participates in hearings involving decisions on waiver services.
• Coordinates Medicaid Administrative Claims (MAC), Targeted Case Management (TCM), and other revenue sources.

Skills

Regulatory compliance

Financial analysis

Supervisory experience

Leadership

Education

Bachelor’s degree in related field

Master’s Degree in related field

Service and Support Administration Supervisor Certification

Tools

PAWS familiarity

MRC knowledge

Job description

At the Delaware County Board of Developmental Disabilities (DCBDD), we believe every person deserves the opportunity to live, learn, work, and thrive as a valued member of our community. We support individuals with developmental disabilities and their families at every stage of life, connecting them with resources, creating opportunities for inclusion, and empowering them to achieve their goals. Our work is driven by compassion, collaboration, and a deep respect for the dignity and potential of every person we serve. Joining our team means more than just starting a new job, it is becoming part of a mission-driven organization where your skills make a lasting difference in the lives of others and in the heart of our growing community.

Mission

To inspire, empower, and support people to achieve their full potential.

Vision

All people will lead personally fulfilling lives.

Candidates must model the following established core values: Inclusion, Equity, and Integrity

Supervisory responsibility

Supervises, directs, and evaluates the work of Assessment Specialists and Funding Specialists as assigned

Primary objective

The Medicaid and Funding Manager serves as the agency’s Medicaid Manager and provides leadership and oversight of Medicaid waiver and local funding operations. This role is responsible for ensuring accurate and compliant waiver administration, fiscal analysis, payment authorizations, and funding utilization while supervising assigned funding staff. The position collaborates closely with internal departments, providers, and external partners to ensure effective service delivery, regulatory compliance, and sound fiscal stewardship in support of individuals served by the Board.

Minimum qualifications

Bachelor’s degree in related field and five (5) years of experience with Medicaid Waiver services; Master’s Degree in related field and three (3) years of supervisory experience preferred; an equivalent combination of experience and education sufficient to perform the essential job functions and provide the required knowledge and abilities is qualifying.

Service and Support Administration Supervisor Certification per OAC 5123-5-02 preferred, or the ability to obtain at time of appointment and maintain throughout employment.

Must possess a valid State of Ohio Driver's License and acceptable driving record as stipulated by the Board’s insurance carrier.

Physical requirements

Sedentary work strength level. The physical requirements of the position are identified as sedentary work, which may require the lifting of up to 10 pounds occasionally.

The physical activity of the position is manual dexterity, talking, hearing, reaching, and navigating your environment.

Ability to operate standard office equipment in the performance of essential functions (e.g. copy machine, fax machine, personal computer, and telephone.).

Other requirements

• Serves as the agency Medicaid Manager; performs all duties and functions related to Medicaid management including, but not limited to, waiver projections, match calculations, analysis, and reconciliation functions.
• Supervises, directs, and evaluates the work of Assessment Specialists and Funding Specialists as assigned; recommends corrective/disciplinary action as determined necessary.
• Acts as a liaison to and between Service & Support Administration (SSA) Supervisors, Service & Support Administrators, and providers to ensure a better understanding of the Payment Authorization for Waiver Services (PAWS), billing, revisions, initial enrollments, and redetermination as it relates to the waiver fiscal functions; provides guidance and solutions for complex issues and questions related to these functions.
• Develops and maintains a strong knowledge of Ohio Administrative Code, Ohio Revised Code, and waiver amendments related to waiver administration such as Medicaid covered services, waiver services, congregate settings, and ratios of service.
• Research payment status for waiver services and collects additional information and corrects or coordinates correction of any errors as needed.
• Serves as liaison to Delaware County Job and Family Services regarding waiver-related eligibility functions; communicates issues to Directors and SSA Supervisors as appropriate.
• Provides technical assistance for payment authorizations activities.
• Manages waiver allocation in collaboration with the Assistant Superintendent, Senior Director of Operations and Finance, and the Senior Director of Programs and Services.
• Prepares for and participates in all hearings involving decisions made by DCBDD regarding waiver services.
• Acts as Coordinator/Claims processor for Medicaid Administrative Claims (MAC), Targeted Case Management (TCM), Title XX, Rental Assistance Program, and other assigned revenue sources.
• Provides fiscal analysis and reports to the Superintendent as requested.
• Oversees and ensures appropriate PAWS and local funding authorization entries; assures timely submission of PAWS forms to DODD for processing.
• Manages the utilization of services to revise waiver and locally funded budgets on an on-going basis to compare actual billing to authorized services to recoup unused funds when services are authorized, but not used.
• Provides oversight to ensure that budgets are accurately prepared and implemented; ensures accuracy and timeliness of authorizations to ensure proper payment for providers; reviews requests for increases in services to ensure they are warranted.
• Oversees and ensures the timely and accurate payment of invoices and other fiscal assignments.
• Assists with the development of policies and procedures regarding operations, Medicaid Management, PAWS, Monthly Rate Calculator (MRC) and local funding authorizations; implements procedures and manages workflow in a manner that complements the goals and objectives of DCBDD.
• Carries out the administration process of Medicaid and waiver-related services.
• Participates in DODD and Auditor of State reviews and audits; assists in the development of and completion of plans of correction as assigned.
• Assists the Senior Director of Operations and Finance with the annual agency budget, annual cost report, five (5) year fiscal forecast, and any other reports as assigned.
• In the absence of the Senior Director of Operations and Finance, acts as their designee when assigned, for Department operational needs.
• Regular attendance, as governed by and in accordance with applicable rules, regulations, procedures and laws, is regarded as an essential requirement of this classification.
• Adheres to all CFR, ORC, OAC, and DCBDD policies and procedures.
• Performs other related duties and special projects as assigned.

DCBDD IS AN EQUAL OPPORTUNITY EMPLOYER