CAU Eligibility Specialist

University of New Orleans; Baton Rouge, Northern (LA, KY); Hybrid; USD 40,000 - 50,000; Full time

Job summary

LSU New Orleans seeks a Medicaid eligibility specialist to manage appeals and determine eligibility, ensuring timely reversals and notices within deadlines. You will review data in LaMEDS and related Medicaid systems to support applications and renewals.

The role requires a Bachelor’s degree or 6 years of equivalent experience, strong analytical and communication skills, and the ability to interpret federal and state policies. Training and reporting duties are included.

Qualifications

• Bachelor’s degree or 6 years of professional experience in lieu of degree.
• 2 years of professional experience determining Medicaid eligibility.
• Experience with LaMEDS is required.
• Excellent analytical, organizational and communication skills.
• Advanced degree is desired.

Responsibilities

• Timely complete appeal actions to re-open and close cases per appeal status.
• Prepare eligibility decision notices by inputting data into Medicaid systems.
• Maintain knowledge of Medicaid policies and procedures and apply updates.
• Develop and produce reporting based on appeals data to influence decisions.

Skills

Medicaid eligibility

Data analysis

Attention to detail

Education

Bachelor’s degree or 6 years of professional experience in lieu of degree

Tools

LaMEDS system

Medicaid systems

Job description

Job Summary

Timely complete appeal actions to re-open and/or close cases in accordance with appeal status. Take precautions to not re-notice appellants when taking these actions. Process CAU reversals which will include clearing issues and discrepancies in LaMEDS to assist with the processing of applications and renewals. Review data systems to determine what action needs to be performed. Maintain controls to ensure reversals are completed within required deadlines. Document eligibility research electronically in the required Medicaid system applications. Prepare eligibility decision notices by inputting required data into the corresponding Medicaid application systems, as necessary. Maintain knowledge of Medicaid policies and procedures and ensure that any new changes, updates or clearances are applied accordingly. Maintain knowledge and usage of all verification systems the agency has access to. Interpret and apply complex federal, state, and agency policy. Employ rudimentary knowledge and terminology of legal, medical and business areas, including real estate and insurance. Trend and analyze appeals data both regionally and statewide. Develop and produce reporting based on appeals data to influence training needs and decision making. Attend and participate in required meetings and trainings. Other tasks as directed.

Job Description

Timely complete appeal actions to re-open and/or close cases in accordance with appeal status. Take precautions to not re-notice appellants when taking these actions. Process CAU reversals which will include clearing issues and discrepancies in LaMEDS to assist with the processing of applications and renewals. Review data systems to determine what action needs to be performed. Maintain controls to ensure reversals are completed within required deadlines. Document eligibility research electronically in the required Medicaid system applications. Prepare eligibility decision notices by inputting required data into the corresponding Medicaid application systems, as necessary. Maintain knowledge of Medicaid policies and procedures and ensure that any new changes, updates or clearances are applied accordingly. Maintain knowledge and usage of all verification systems the agency has access to. Interpret and apply complex federal, state, and agency policy. Employ rudimentary knowledge and terminology of legal, medical and business areas, including real estate and insurance. Trend and analyze appeals data both regionally and statewide. Develop and produce reporting based on appeals data to influence training needs and decision making. Attend and participate in required meetings and trainings. Other tasks as directed.

Qualifications Required

QUALIFICATIONS REQUIRED: Bachelor’s degree or 6 years of professional experience in lieu of degree. 2 years of professional experience determining Medicaid eligibility. Current working knowledge of the LaMEDS system. Excellent analytical skills, effective organizational and time management skills. Great attention to detail and follow up. Excellent verbal and written communication skills. DESIRED: Advanced degree. Minimum 4 years of professional experience in determining Medicaid eligibility. Minimum 2 years of professional experience working with Medicaid appeals process. Advanced knowledge of the LaMEDS system. Experience with data analysis and research.

Salary

SALARY: 40-50k

About LSU New Orleans

LSU New Orleans is the only R2 public research university in New Orleans, Louisiana, and one of just four public colleges in Louisiana to hold that designation. R2 status opens the doors to competitive federal research grants that flow preferentially to classified research universities. It anchors the university’s power to recruit research-active faculty, to sustain doctor programs of national standing, and to signal to businesses and investors that New Orleans possesses the intellectual infrastructure a knowledge economy demands. Located along Lake Pontchartrain in New Orleans, LSU New Orleans’ research excellence and urban relevance provide an opportunity for the institution to become a leading public research partner in one of America’s most exciting and vibrant metropolitan areas. New Orleans has always faced challenges that call for research driven solutions including coastal land loss, educational achievement gaps, affordability, public safety, and workforce shortages. LSU New Orleans can strengthen its research activity as a tool for public problem solving as well as economic impact by leveraging the scale, reputation, infrastructure, and global reach of the LSU enterprise while remaining deeply connected to the city it serves. With more than 5,500 students and the support of approximately 248 faculty serving the College of Liberal Arts & Human Development, The college of Sciences, The Robert A. Savoie College of Engineering, the Henry Berstein College of Business Administration, and six distinct schools, the campus remains committed to honoring its founding vision and continuing to play a critical role in the region. Opened in 1958 on the site of a former U.S. Naval Air Station as the region’s first fully integrated public university, LSU New Orleans was created after years of coordinated efforts from civic leaders and residents who believed that an accessible public institution of higher education was vital to the city’s future. Located only 15 minutes away from downtown and the French Quarter, the university occupies a 195-acre campus in one of the nicest residential areas of the city.Since its first commencement exercises in 1962, the university has conferred more than 80,000 degrees creating an extensive network of Privateer Alumni that includes prominent local leaders in fields such as business, tourism, athletics, government, and academia. The university is also an important catalyst of socio-economic mobility for the region. Its student body includes a significant share of first-generation students, working students, adult learners, and veterans.The institution has grown from a commuter-oriented campus into a comprehensive urban research university with undergraduate, graduate, and doctoral programs in distinctive academic categories tied to the city and region. Its evolution has been inseparable from the story of New Orleans; an internationally recognized city of creativity, resilience, industry, cultural influence, and global connectivity. As one of the most strategically important cities in America, New Orleans’s economy is rooted in legacy sectors such as energy, maritime commerce, tourism, healthcare, and international trade. Recently, the city has expanded its economic portfolio to include areas such as coastal restoration, film and media production, technology, and advanced manufacturing. The city’s strengths are the university’s opportunities. New Orleans needs talent, civic leadership, resilient infrastructure, healthcare innovation, artists, and entrepreneurs. This combination of culture, commerce and connectivity gives LSU New Orleans a set of dynamic factors that allows it to serve as both an access institution and a problem-solving university as it reinvents itself beginning this summer.

LSU New Orleans seeks to recruit a highly productive workforce and will provide equal employment opportunities to all employees and prospective employees. Employment decisions shall be based strictly on merit and without regard to religious or political beliefs, sex, race, or any other non-merit factor.

LSU New Orleans Welcomes Job Applicants from Varied Backgrounds LSU New Orleans seeks to recruit a highly productive workforce and will provide equal employment opportunities to all employees and prospective employees. Employment decisions shall be based strictly on merit and without regard to religious or political beliefs, sex, race, or any other non-merit factor.