Centralized Appeals Unit - Coordinator 1

University of New Orleans; United States; On-site; USD 43,000 - 53,000; Full time

Job summary

LSU New Orleans seeks a qualified reviewer for Medicaid appeals. You will analyze appeals for policy accuracy, draft supporting documents, and manage electronic case records and SharePoint submissions.

You will coordinate with reviewers, monitor corrective actions by field staff, and attend hearings as needed while staying current with Medicaid policies and procedures.

Qualifications

• Bachelor's degree or 3 years professional experience, or 6 years in lieu of degree.
• Strong analytical, organizational and time-management skills.
• Attention to detail with strong verbal and written communication.

Responsibilities

• Review, analyze, and investigate assigned appeals for policy-based accuracy.
• Draft and assemble appeals documents including cover memoranda and evidence summaries.
• Upload documents to Medicaid ECS and LDH SharePoint; notify reviewer.
• Monitor case status and ensure corrective actions by field staff.
• Attend hearings and stay current with Medicaid policies and procedures.

Skills

Analytical skills

Organization

Time management

Verbal & written communication

Attention to detail

Independent and team player

Education

Bachelor's degree or equivalent

Tools

Adobe Acrobat Pro

Microsoft Office

Job description

Job Summary

Review, analyze, and investigate assigned appeals to determine if the proposed action taken by field staff was accurate based on policy, procedure, and information found within the various Medicaid systems. Draft and assemble the following documents: appeals cover memoranda; summaries of evidence; agency reversals which will include e-mails to staff notifying that a corrective action needs to be taken and letters to the appellants explaining the action taken; withdrawals; and untimely request documents. Forward the Summary of Evidence, reversal or withdrawal to assigned reviewer, make edits recommended by reviewer. Upload appeals documents into Medicaid’s Electronic Case Record and upload the documents to the Division of Administrative Law/LDH SharePoint site. Notate the Case Notes indicating that the uploading has been completed and notify the Centralized Appeals Unit's representative assigned to track the appeal that the necessary documents have been uploaded and mailed to the appellant where applicable. Monitor the reviewed cases for corrective actions taken by field staff. Determine if all required corrective actions have been taken and email the field staff if further corrective actions are required. Mail a copy of the Summary of Evidence to the appellant or, if applicable, ensure that a copy of the reversal is mailed to the appellant, and notify the Centralized Appeals Unit's representative assigned to track the appeal that it has been mailed and notate same in the Electronic Case Record. Review changes to Medicaid policy and procedures and attend meetings with Medicaid staff as necessary. Attend telephone and in person hearings, and cover hearings for employees who are not able to attend. Maintain knowledge of all Medicaid policies and procedures, and ensure that any new changes, updates and/or clearances are applied accordingly. Other tasks as directed.

Qualifications

• Bachelor's degree, or an Associate's degree plus three years of professional experience, or six years of professional experience in lieu of degree.
• Excellent analytical skills, effective organizational and time management skills.
• Great attention to detail and follow up, and verbal/written communications skills.
• Works well both independently and as part of a team.
• Ability to set, follow, and meet deadlines.
• Proficient in the use of Adobe Acrobat Pro as well as Microsoft Office Suite (Word, Excel, PowerPoint, and Outlook).

Desired

• Advanced degree.
• Minimum one year of professional experience with Medicaid appeals processes and procedures.
• Minimum one year professional experience with Medicaid eligibility including MAGI, Non-MAGI, Long Term Care and HCBW programs.
• Minimum one year of professional experience working in the Medicaid eligibility system LaMEDS.
• Industry-related certifications such as HIM, RHIA, RHIT, CDI, CHDA.

Salary

43-53k

Required Attachments

• Detailed resume listing relevant qualifications and experience
• Cover Letter indicating why you are a good fit for the position and LSU New Orleans
• Names and contact information of three references

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.

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.

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 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.