Medicaid Eligibility Quality Specialist II

LDH-Medical Vendor Administration; Baton Rouge (LA); On-site; USD 52,000 - 78,000; Full time

Job summary

The Louisiana Department of Health is seeking a Medicaid Program Specialist 2 to join the Medicaid Eligibility Quality team in East Baton Rouge Parish. The role focuses on reviewing complex eligibility cases, reconciling discrepancies, supporting appeals, and ensuring accurate, timely Medicaid decisions in line with federal requirements.

Ideal candidates are detail-oriented, analytical, and dedicated to improving access to essential healthcare for Louisianans.

Qualifications

• Four years of experience in research and analysis related to Medicaid programs; public health, public relations, social services, health services, or administrative services; OR
• Six years of full-time work experience in any field plus one year of experience in research and analysis related to Medicaid programs; public health, public relations, social services, health services, or administrative services; OR
• A bachelor's degree plus one year of experience in research and analysis related to Medicaid programs; public health, public relations, social services, health services, or administrative services; OR
• An advanced degree or a Juris Doctorate.

Responsibilities

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

Skills

Communicating Effectively

Demonstrating Accountability

Thinking Critically

Education

Bachelor's degree

Advanced degree or Juris Doctorate

Tools

LaMEDS

Job description

The Louisiana Department of Health is seeking a Medicaid Program Specialist 2 to join the Medicaid Eligibility Quality team in East Baton Rouge Parish. The role focuses on reviewing complex eligibility cases, reconciling discrepancies, supporting appeals, and ensuring accurate, timely Medicaid decisions in line with federal requirements.

Ideal candidates are detail-oriented, analytical, and dedicated to improving access to essential healthcare for Louisianans.