Medicaid Eligibility & Appeals Specialist

University of New Orleans; Baton Rouge (LA); Hybrid; USD 40.000 - 50.000; Vollzeit

Zusammenfassung

LSU New Orleans is seeking an Eligibility Support professional to timely process Medicaid appeals, reversals, and eligibility determinations. You will analyze LaMEDS data, review policies, and generate reports to guide training and decisions.

Strong communication and detail-oriented skills are essential for success in this role. Applicants should have a Bachelor’s degree or equivalent experience, plus experience with Medicaid eligibility and appeals.

Qualifikationen

• 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.
• Advanced degree.
• Minimum 4 years of professional experience in determining Medicaid eligibility.
• Minimum 2 years of professional experience working with Medicaid appeals.
• Advanced knowledge of the LaMEDS system.
• Experience with data analysis and research.

Aufgaben

• 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 including clearing issues and discrepancies in LaMEDS.
• Review data systems to determine required actions.
• Maintain controls to ensure reversals are completed within deadlines.
• Document eligibility research electronically in Medicaid systems.
• Prepare eligibility decision notices by inputting data into Medicaid applications.
• Maintain knowledge of Medicaid policies and procedures and update accordingly.
• Maintain knowledge and usage of verification systems the agency uses.
• Interpret and apply complex federal, state, and agency policy.
• Trend and analyze appeals data regionally and statewide.
• Develop and produce reporting based on appeals data to influence training and decisions.
• Attend required meetings and trainings; perform other tasks as directed.

Kenntnisse

Analytical skills

Organizational skills

Time management

Attention to detail

Verbal communication

Written communication

Ausbildung

Bachelor’s degree or 6 years of professional experience

Advanced degree

Tools

LaMEDS system

Jobbeschreibung

LSU New Orleans is seeking an Eligibility Support professional to timely process Medicaid appeals, reversals, and eligibility determinations. You will analyze LaMEDS data, review policies, and generate reports to guide training and decisions.

Strong communication and detail-oriented skills are essential for success in this role. Applicants should have a Bachelor’s degree or equivalent experience, plus experience with Medicaid eligibility and appeals.