JOB SUMMARY

Provides executive-level leadership, strategic direction, and oversight of the district’s Medicaid programs, including School Health and Related Services (SHARS), Medicaid Administrative Claiming (MAC), and Random Moment Time Study (RMTS). Serves as the district’s subject matter expert on Medicaid reimbursement strategy, compliance, and optimization. Drives revenue maximization, operational excellence, and cross-functional alignment with Special Education, Finance, Compliance, and external partners.

Leads the development and execution of long-term strategies to expand Medicaid and other enterprise fund revenue, ensure regulatory compliance, enhance systems and processes, and improve service delivery impacting student outcomes. Oversees program integrity, audit readiness, and risk mitigation while building organizational capacity through leadership, training, and performance management.

MAJOR DUTIES & RESPONSIBILITIES

1. Provides strategic leadership and direction for all Medicaid programs (SHARS, MAC, RMTS), ensuring alignment with district priorities, financial goals, and regulatory requirements.
2. Develops and executes a comprehensive Medicaid revenue strategy, including forecasting, optimization initiatives, and expansion of reimbursable services.
3. Oversees district-wide compliance with federal and state Medicaid regulations, IDEA requirements, and audit standards; leads all audit responses, corrective action plans, and monitoring systems.
4. Serves as the primary liaison with state agencies, third-party administrators, auditors, and consultants to ensure program integrity and maximize reimbursement opportunities.
5. Leads cross-functional collaboration with Special Education, Finance, IT, Compliance, and campus leadership to ensure accurate documentation, service delivery, and billing practices.
6. Establishes and monitors key performance indicators (KPIs) and dashboards to track Medicaid claiming effectiveness, compliance, and revenue performance.
7. Directs the design, implementation, and continuous improvement of systems and processes (e.g., eSHARS, RMTS, IEP systems) to enhance efficiency, accuracy, and scalability.

MAJOR DUTIES & RESPONSIBILITIES CONTINUED

8. Oversees training strategy and execution for clinicians, campus staff, and administrators to ensure high-quality documentation and compliance with Medicaid requirements.
9. Leads data analysis efforts to identify trends, gaps, and opportunities for improved claiming, service delivery, and financial performance.
10. Manages and develops a team of managers and professional staff, establishing clear expectations, accountability structures, and succession planning.
11. Develops and manages the Medicaid program budget, including vendor contracts, cost allocation, and return-on-investment analysis.
12. Advises executive leadership on Medicaid-related risks, opportunities, and policy changes; provides recommendations to inform strategic decisions.
13. Oversees customer service and stakeholder engagement strategies to ensure strong partnerships with campuses, departments, and external entities.
14. Leads special projects and initiatives related to Medicaid, healthcare funding, special education (IEP) management systems, and integrated service delivery models.
15. Other duties as assigned.

EDUCATION

Bachelor's Degree

WORK EXPERIENCE

5 to 7 years

SKILL AND/OR REQUIRED LICENSING/CERTIFICATION

Advanced knowledge of Medicaid programs (SHARS, MAC, RMTS) Experience with eSHARS, IEP systems, financial systems, and data analytics tools Proficiency in Microsoft Office Suite and data visualization tools

LEADERSHIP RESPONSIBILITIES

Senior Management. Manages a department or multiple major disciplines, often through subordinate management. Regularly manages staff in the completion of large-scale projects or a very closely related set of projects/initiatives often spanning multiple disciplines. Receives strategies and broad departmental objectives from senior leadership; establishes operational objectives and work plans; delegates assignments to subordinate management and staff. Allocates resources according to priorities and serves as the primary decision maker regarding hiring, performance, and budget.

WORK COMPLEXITY/INDEPENDENT JUDGMENT

Work is substantially complex, varied and regularly requires the selection and application of technical and detailed guidelines. Independent judgment is required to identify, select, and apply the most appropriate methods as well as interpret precedent. Position regularly makes recommendations to management on areas of significance to the department. Supervision received typically consists of providing directions on the more complex projects and new job duties and priorities.

BUDGET AUTHORITY

Participates in a group plan and/or budget development.

PROBLEM SOLVING

Decisions are made with greater freedom and discretion, including recommendations that are subject to approval on matters that may affect multiple departments across HISD. Job is frequently expected to recommend new solutions to problems, to improve existing methods/procedures/services and generate new ideas. May also review decisions made by other individuals on more routine matters.

IMPACT OF DECISIONS

Decisions have moderate impact to the facility/department or division, causing increased satisfaction or dissatisfaction; producing efficiencies or delays; promoting or inhibiting personal intellectual or professional development; and/or contributing to financial gain or expense. Errors may be serious, usually not subject to direct verification or check, causing losses such as improper cost calculations, overpayment or improper utilization of labor, materials, or equipment. Effects are usually confined to the organization itself and are short term.

COMMUNICATION/INTERACTIONS

Negotiate and influence - interpret department strategies and services, resolves conflicts, influences outcomes on matters of significance for the division, conducts final negotiations and coordinates approvals/decision making below the executive level. Interactions are typically with customers and Top Management.

CUSTOMER RELATIONSHIPS

Anticipates customer needs, identifies, and champions opportunities for the development and implementation of new services and methods to meet or exceed customer needs. Establishes customer service standards and feedback mechanisms across departments and client districts.

WORKING/ENVIRONMENTAL CONDITIONS

Typical office environment with occasional travel to campuses or meetings, including out-of-town travel to meet with client districts or state agencies. May require extended hours during audit periods or major initiatives.