Medicaid Eligibility & Appeals 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

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.