Medicaid Eligibility Quality Analyst II

State of Louisiana; Baton Rouge (LA); On-site; USD 52,000 - 73,000; Full time

Job summary

The Louisiana Department of Health is seeking a Medicaid Program Specialist 2 to review complex eligibility cases and resolve discrepancies to ensure accurate, timely decisions in line with Medicaid policy and federal requirements. This role focuses on ensuring access to healthcare for Louisianans through detailed analysis and compliance with program rules.

The ideal candidate brings strong analytical skills, knowledge of Medicaid processes, and the ability to navigate multiple systems to

Qualifications

• Four years of experience in research and analysis related to Medicaid programs or similar fields.
• Six years of full-time work experience plus one year in Medicaid-related research and analysis; OR bachelor’s degree with one year in Medicaid analytics.
• Advanced degree or JD can substitute for experience per state rules.

Responsibilities

• Reviews and analyzes assigned Medicaid eligibility cases to determine accuracy and appropriateness of actions by field staff.
• Investigates eligibility information and resolves case discrepancies using Medicaid policies and systems.
• Processes Medicaid applications, renewals, case changes, and appeals accurately within federally mandated timeframes.
• Re-processes eligibility determinations and clears issues in LaMEDS for timely case actions.
• Reviews cases for compliance with Medicaid eligibility requirements and regulations.
• Prepares eligibility decision notices by entering required information into Medicaid systems.
• Maintains current knowledge of verification systems, policies, and program updates to support accurate determinations.

Skills

Communicating Effectively

Demonstrating Accountability

Thinking Critically

Education

Bachelor's degree + 1 year Medicaid-related experience

Advanced degree or Juris Doctorate

Four years of Medicaid-related research/analysis experience

Six years of full-time work + one year Medicaid experience

Job description

The Louisiana Department of Health is seeking a Medicaid Program Specialist 2 to review complex eligibility cases and resolve discrepancies to ensure accurate, timely decisions in line with Medicaid policy and federal requirements. This role focuses on ensuring access to healthcare for Louisianans through detailed analysis and compliance with program rules.

The ideal candidate brings strong analytical skills, knowledge of Medicaid processes, and the ability to navigate multiple systems to