Medicaid Program Integrity Analyst

State of Louisiana; Baton Rouge (LA); On-site; USD 55,000 - 75,000; Full time

Job summary

Louisiana Department of Health seeks a skilled professional to analyze complex Medicaid eligibility data, conduct post-eligibility reviews, and support the Centralized Appeal Unit in hearings. You will verify determinations, document findings, and maintain LaMEDS data with accuracy.

The role involves interpreting federal/state policies, handling inquiries, and reporting trends to improve program integrity for Louisiana residents.

Qualifications

• Six years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services.
• Six years of full-time work experience in any field plus three years in health/public service program development/evaluation; or a bachelor’s degree with three years in health/public service program development/evaluation; or an advanced degree/JD with two years in such work.

Responsibilities

• Conduct post-eligibility reviews of Medicaid/LaCHIP eligibility determinations, evaluating financial and non-financial factors for compliance with applicable state and federal requirements.
• Review income and other eligibility data from federal and state systems to verify determinations.
• Document case findings, corrective actions, policy references, and case activity in appropriate systems and files, and issue required written notifications to applicants and enrollees.
• Update and maintain eligibility information in LaMEDS, determine current eligibility, and authorize final eligibility decisions.
• Support the Centralized Appeal Unit by assisting with fair hearing requests and representing the agency during hearings when needed.
• Interpret and apply complex federal, state, and agency policies, and provide assistance with quality control reviews, payment error responses, provider or member inquiries, and eligibility-related complaints.
• Analyze and report review findings and trends, notify management of recurring errors, and refer appropriate cases to Medicaid Fraud Unit.

Education

Bachelor’s degree in relevant field

Advanced degree or JD in health/public policy

Job description

Louisiana Department of Health seeks a skilled professional to analyze complex Medicaid eligibility data, conduct post-eligibility reviews, and support the Centralized Appeal Unit in hearings. You will verify determinations, document findings, and maintain LaMEDS data with accuracy.

The role involves interpreting federal/state policies, handling inquiries, and reporting trends to improve program integrity for Louisiana residents.