Medicaid Eligibility & Appeals Specialist

University of New Orleans; United States; On-site; USD 40,000 - 50,000; Full time

Job summary

LSU New Orleans is seeking a Medicaid eligibility specialist to support appeal actions, reversals, and eligibility determinations. The role requires interpreting complex policies, maintaining systems knowledge, and producing reporting to guide training and decisions.

The candidate should have a bachelor’s degree or 6 years of relevant experience, plus 2 years of Medicaid eligibility work and strong analytical and communication skills.

Qualifications

• Bachelor’s degree or 6 years of professional experience in Medicaid eligibility.
• 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 per status.
• Avoid re-noticing appellants when taking actions.
• Process CAU reversals to clear issues in LaMEDS for applications and renewals.
• Review data systems to determine required actions.
• Maintain controls to ensure reversals meet deadlines.
• Document eligibility research electronically in Medicaid systems.
• Prepare eligibility decision notices by inputting data into Medicaid apps.
• Maintain knowledge of Medicaid policies and ensure updates are applied.
• Maintain knowledge and use of verification systems available.
• Interpret and apply complex federal, state, and agency policy.

Skills

Analytical skills

Organizational skills

Time management

Attention to detail

Verbal communication

Written communication

Education

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

Advanced degree

Job description

LSU New Orleans is seeking a Medicaid eligibility specialist to support appeal actions, reversals, and eligibility determinations. The role requires interpreting complex policies, maintaining systems knowledge, and producing reporting to guide training and decisions.

The candidate should have a bachelor’s degree or 6 years of relevant experience, plus 2 years of Medicaid eligibility work and strong analytical and communication skills.