Executive Director - Medicaid Program… at Houston… · Houston

Responsibilities

1. Executive Leadership & Program Governance
2. Serve as the district’s executive authority for the SHARS program, providing strategic direction, fiscal governance, and long-term sustainability planning.
3. Advise the CFOO/Controller on SHARS revenue, risk exposure, audit findings, and compliance matters.
4. Fiscal Management & Accounting Oversight
5. Direct all accounting functions related to SHARS revenues, including:
6. Revenue recognition and reconciliation
7. Maintenance of SHARS-specific general ledger accounts
8. Cash receipts, accruals, and adjustments
9. Ensure SHARS revenues are recorded in accordance with HISD standards and financial policies.
10. Prepare and present monthly financial reports detailing SHARS revenue performance, trends, and projections.
11. SHARS Billing & TMHP Claims Administration
12. Oversee the end-to-end SHARS billing cycle in TMHP, ensuring:
13. Accurate submission of claims for eligible SHARS services
14. Timely correction and resubmission of denied or adjusted claims
15. Compliance with TMHP billing manuals, policy updates, and deadlines
16. Establish internal controls to ensure that claims are supported by valid IEPs, provider credentials, and compliant service documentation.
17. State/Federal Compliance and Audit Monitoring
18. Ensure HISD compliance with:
19. Texas Administrative Code related to SHARS
20. HHSC and TMHP SHARS policy manuals
21. Federal Medicaid requirements applicable to school-based services
22. Lead preparation for and response to:
23. TMHP reviews
24. HHSC or TEA monitoring
25. State and federal audits
26. Develop and maintain corrective action plans when required and ensure timely resolution of findings.
27. Coordinate PEIMS/finance alignment and other cross-functional reporting dependencies with district teams as needed.
28. Documentation, Internal Controls & Risk Management
29. Establish and enforce districtwide policies and procedures governing:
30. SHARS documentation standards
31. Provider credential verification
32. Time studies (if applicable)
33. Record retention requirements
34. Conduct periodic internal reviews to identify compliance risks and implement corrective measures.
35. Data Analysis & Revenue Optimization
36. Analyze SHARS data to monitor:
37. Claim acceptance and denial rates
38. Provider productivity
39. Revenue trends by service type
40. Use data to improve billing accuracy, strengthen compliance, and maximize allowable SHARS reimbursement.
41. Interagency Coordination and Communication
42. Serve as HISD’s primary liaison with:
43. Texas Medicaid & Healthcare Partnership (TMHP)
44. Texas Health and Human Services Commission (HHSC)
45. Education Service Centers (ESCs)
46. External auditors and consultants
47. Oversee SHARS vendor contracts, monitor performance, and ensure contract compliance.
48. Other duties as assigned.