Centralized Appeals Unit - Supervisor

LSU New Orleans; New Orleans (LA); On-site; USD 65,000 - 75,000; Full time

Job summary

The University of New Orleans seeks an Eligibility Support professional to manage daily activities within the Eligibility Unit, report metrics, and coordinate with LDH and Medicaid staff.

The role includes QA reviews, training, supervising staff, and developing procedures. Salary ranges from 65,000 to 75,000 USD annually with full-time on-site work at UNO.

Qualifications

• Bachelor's degree or Associate's degree plus three years of professional experience, or six years of professional experience in lieu of degree.
• Minimum three years of professional experience with Medicaid appeals processes and procedures.
• Minimum three years professional experience with Medicaid eligibility including MAGI, Non-MAGI, Long Term Care and HCBW programs.
• Minimum two years of supervisory experience.
• 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).

Responsibilities

• Manage and report on all daily activities within the Eligibility Unit.
• Conduct quarterly meetings with Coordinators and group as needed when new policy or procedures are implemented.
• Perform random quality control reviews of work documents to ensure integrity of output.
• Monitor project deadlines and assist staff with daily operations and project issues.
• Assist in developing standards, procedures, and best practices and maintain unit manuals.
• Provide statistical measurements to LDH regarding unit productivity.
• Serve as a point of contact to Medicaid personnel on eligibility projects and change requests.
• Ensure cases are processed correctly prior to appeal hearings with LDH.
• Conduct needs assessments for training eligibility staff.
• Meet with coordinators to address productivity concerns.
• Develop long/short range plans for staff training and equipment needs.
• Troubleshoot equipment needs and report replacements.
• Disseminate information to staff via verbal and written communication.
• Complete special eligibility quality control research projects as assigned.
• Review Medicaid policy changes and disseminate to staff.
• Interpret and apply complex federal/state policies.
• Guide case reviews and appeal handling; obtain policy clearance when needed.
• Maintain knowledge of Medicaid policies, programs, and procedures; update changes as needed.
• Maintain knowledge of verification systems and SharePoint for internal records.
• Learn staff duties and provide backup when needed.
• Process assignments to meet deadlines or LDH requests; represent the agency at hearings as required.
• Assist CAU Senior Manager with handling inquiries from Governor’s office and LDH related to urgent appeals or updates; report results to LDH.
• Provide customer service to Medicaid applicants or enrollees with denials; resolve issues.
• Conduct annual performance evaluations for subordinates; set goals and strategies.
• Recruitment, interviews, training, supervision, and professional development of staff.
• Collaborate with LDH and UNO policy trainers to ensure staff training and ongoing education.
• Other tasks as directed.

Skills

Analytical skills

Organizational skills

Time management

Verbal/written communication

Independent and teamwork

Deadline orientation

Adobe Acrobat Pro

Microsoft Office Suite

Education

Bachelor's degree

Associate's degree + 3 years experience

Six years experience in lieu of degree

Tools

Adobe Acrobat Pro

Microsoft Office Suite

Job description

Department Eligibility Support

Manage and report on all daily activities within the Eligibility Unit. Conduct Quarterly meetings with Coordinator 2s and meet with the entire group as needed when new policy or procedures have been implemented. Perform random quality control reviews of work documents to ensure a high level of integrity of the work output. Monitors project deadlines to confirm deadlines are met and provide assistance to subordinate staff regarding daily operation and project issues. Assist in the development of standards, procedures, and best practices, including internal department documentation, to ensure efficient and effective division operations. Maintain Unit manuals/documents and ensure they remain current with the latest updates and clearances. Assist with assembling and providing statistical measurements to LDH regarding Unit’s work output and productivity efforts, this may be completed monthly, quarterly, yearly or at any time upon request from LDH or UNO. May act as point of contact to Medicaid personnel regarding current and future Eligibility unit projects and change requests. Work with LDH to ensure cases are processed correctly prior to appeal hearing. Assist the CAU Senior Manager in conducting needs assessment/consultation for training of eligibility staff. Conduct conferences or counseling sessions with coordinators who may be lacking in work productivity. Assists the CAU Senior Manager with developing long and short range plans for the Eligibility staff’s organization, training, and equipment needs. Trouble shoot equipment needs if possible and report any needed replacements. Disseminate all pertinent information to staff through verbal and written communication. Complete special eligibility quality control research projects as assigned by the CAU Senior Manager. Review changes to Medicaid policy and procedures and disseminate information to staff. This will involve attending meetings with LDH Medicaid staff and provide written process changes to the Unit. Interpret and apply complex federal, state, agency policies. Provide guidance on case reviews, handling of appeal requests and request policy clearance when necessary. Maintain knowledge of all current Medicaid policies, programs and procedures and ensure new changes, updates or clearances are applied accordingly. Maintain knowledge and usage of all verification systems the agency has access to establish eligibility and SharePoint sites for maintaining internal records. Learn and maintain knowledge of all employees’ duties and provide back up if someone is out. Process assignments in order to meet Agency Regulation deadline or upon LDHs request and represent the agency on a hearing as required. Assist the CAU Senior Manager with handling inquiries forwarded from the Governor’s office and/or forwarded from LDH regarding upset citizens wanting to appeal the denial of Medicaid benefits or requesting updates on their case and report results back to LDH. Provide customer service to Medicaid applicants or enrollees who may be upset about being denied coverage and resolve any issues. Conduct an annual performance evaluation for each subordinate, setting future goals and strategies. Conduct recruitment, interviews, selection, training, supervision, and professional development of assigned staff. Work with LDH and UNO policy trainers to ensure new employees are properly trained and provide continuous training to current employees. Other tasks as directed.

QUALIFICATIONS REQUIRED:

• Bachelor's degree, or an Associate's degree plus three years of professional experience, or six years of professional experience in lieu of degree.
• Minimum three years of professional experience with Medicaid appeals processes and procedures.
• Minimum three years professional experience with Medicaid eligibility including MAGI, Non-MAGI, Long Term Care and HCBW programs.
• Minimum two years of supervisory experience.
• 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 four years of professional experience with Medicaid appeals processes and procedures.
• Minimum four years professional experience with Medicaid eligibility including MAGI, Non-MAGI, Long Term Care and HCBW programs.
• Minimum four years of professional experience working in the Medicaid eligibility system LaMEDS.
• Minimum three years of supervisory experience.

SALARY: 65-75k

This position may require a criminal background check to be conducted on the candidate(s) selected for hire.

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.