CAU Eligibility Specialist

LSU New Orleans; New Orleans (LA); On-site; USD 40,000 - 50,000; Full time

Job summary

The University of New Orleans is seeking an Eligibility Support specialist to process Medicaid appeals and ensure accurate eligibility determinations. You will review data systems, apply policies, and generate notices, working to meet deadlines.

Strong analytical, organizational, and communication skills are essential, along with knowledge of LaMEDS and the ability to handle complex federal, state, and agency requirements. Posting remains open until filled.

Qualifications

• 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.

Responsibilities

• Timely complete appeal actions to re-open and/or close cases in accordance with appeal status.
• 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.

Skills

Analytical skills

Organizational skills

Time management

Verbal communication

Written communication

Attention to detail

Education

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

Tools

LaMEDS system

Job description

Thank you for your interest in The University of New Orleans. Once you start the application process, you will not be able to save your work, so you should collect all required information before you begin. The required information is listed below in the job posting. You must complete all required portions of the application and attach the required documents in order to be considered for employment.

Department Eligibility Support Job Summary 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

• 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: 40-50k

Required Attachments

• Detailed resume listing relevant qualifications and experience;
• Cover Letter indicating why you are a good fit for the position and University of Louisiana Systems;
• Names and contact information of three references;
• Applications that do not include the required uploaded documents may not be considered.

Posting Close Date

This position will remain open until filled.

This position may require a criminal background check to be conducted on the candidate(s) selected for hire. As part of the hiring process, applicants for positions at the University of New Orleans may be required to demonstrate the ability to perform job-related tasks. The University of 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.