MEDICAID PROGRAM SPECIALIST 1-2

Nunez Community College; Baton Rouge (LA); On-site; USD 45,000 - 60,000; Full time

Job summary

Louisiana Department of Health is seeking a Medicaid Program Specialist to serve as the first point of contact for members, providers, and partners. You will resolve questions, guide eligibility, and help callers access Medicaid coverage and services with a customer-focused approach.

The role emphasizes accurate information, timely case actions, and escalation when necessary, within the East Baton Rouge operations. A strong emphasis on professional communication and problem solving is required.

Qualifications

• Three 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; OR
• A bachelor's degree.

Responsibilities

• Receive and respond to inbound calls from Medicaid members, potential members, providers, and other stakeholders, providing professional and courteous customer service.
• Provide accurate information and guidance regarding Medicaid programs, eligibility requirements, policies, procedures, and available services.
• Research and communicate case status and eligibility information using LaMEDS and other eligibility and ancillary systems.
• Process case actions, including duplicate card requests, case changes, and adding or removing individuals from cases.
• Review and interpret case notes, notices, and eligibility determinations to accurately address caller inquiries and resolve issues.
• Identify trends, potential errors, and discrepancies in communications, notices, or eligibility determinations and elevate issues through the appropriate chain of command.
• Educate callers and resolve inquiries whenever possible during the initial contact to help prevent delays, reduce gaps in coverage, and support timely access to Medicaid services.

Skills

Communicating

Customer focus

Critical thinking

Decision making

Adaptability

Education

Bachelor's degree

Tools

LaMEDS

Job description

The mission of the Louisiana Department of Health is to protect and promote health and to ensure access to medical, preventive, and rehabilitative services for all residents of the State of Louisiana.

Learn more about the Louisiana Department of Health

Make a difference with every call! As a Medicaid Program Specialist, you’ll serve as a trusted first point of contact for Medicaid members, potential members, providers, and partners. Use your knowledge of Medicaid programs and eligibility to resolve questions, assist with case actions, and help callers access the coverage and services they need. If you’re knowledgeable, compassionate, and ready to make a meaningful impact through exceptional customer service, we encourage you to apply!

An ideal candidate should possess the following competencies:

Communicating Effectively

The ability to convey information, ideas, and emotions using structured communication methods that promote understanding and engagement.

Focusing on Customers:

The ability to understand and meet the needs, preferences, and experiences of internal and external customers.

Thinking Critically:

The ability to analyze information objectively, identify connections across sources, and form logical, well supported conclusions.

Acting Decisively:

The ability to make timely, confident decisions using sound reason.

Adapting to Change

The ability to demonstrate flexibility in thoughts, behaviors, and actions in response to evolving circumstances or unexpected change.

Demonstrating Initiative

The ability to assess situations independently and take proactive steps to address them without being prompted or instructed by others

Displaying Professionalism:

The ability to uphold workplace standards through consistent conduct, responsible communication, and consideration for others.

Learning Actively:

The ability to pursue learning, seek feedback, and integrate new knowledge to improve personal and professional performance.

Managing Time:

The ability to prioritize tasks, meet deadlines, and allocate time to ensure timely completion of work goals.

Solving Problems

The ability to identify root causes, analyze relevant data, and apply practical or innovative solutions to challenges

Required Qualifications

• Three 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; OR
• A bachelor's degree.

EXPERIENCE SUBSTITUTION

Every 30 semester hours earned from an accredited college or university will be credited as one year of experience towards the six years of full-time work experience in any field. The maximum substitution allowed is 120 semester hours which substitutes for a maximum of four years of experience in any field.

Job Duties:

• Receive and respond to inbound calls from Medicaid members, potential members, providers, and other stakeholders, providing professional and courteous customer service.
• Provide accurate information and guidance regarding Medicaid programs, eligibility requirements, policies, procedures, and available services.
• Research and communicate case status and eligibility information using LaMEDS and other eligibility and ancillary systems.
• Process case actions, including duplicate card requests, case changes, and adding or removing individuals from cases.
• Review and interpret case notes, notices, and eligibility determinations to accurately address caller inquiries and resolve issues.
• Identify trends, potential errors, and discrepancies in communications, notices, or eligibility determinations and elevate issues through the appropriate chain of command.
• Educate callers and resolve inquiries whenever possible during the initial contact to help prevent delays, reduce gaps in coverage, and support timely access to Medicaid services.

Position-Specific Details:

Location: Medical Vendor Administration / Eligibility Field Operations / CSU / East Baton Rouge

Appointment Type: Probational, Job Appointment (temporary appointment that may last up to 48 months), Promotional or Detail appointment of a current classified LDH employee.

Cost Center: 305-2050411

Position Number(s): 50473474, 50391497, 50656232 & 50661288

Career Progression: This position may be filled as a Medicaid Program Specialist 1 or 2 depending on the qualifications of the selected applicant.

Compensation: This position is eligible for Premium Pay of up to $2.00/hr for hours worked based on longevity.

Bilingual applicants may be eligible for premium pay up to $2.50 hourly for hours worked only.

Contact Information

[e-mail]

LA Department of Health (LDH)

Division of Human Resources

PO Box 4818

Baton Rouge, LA 70821

225-342-6477

This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218.

LDH supports Louisiana’s commitment to being a State as a Model Employer (SAME) by promoting the recruitment, hiring, and retention of individuals with disabilities.

Information on Louisiana Works, Louisiana Rehabilitation Services is available here.

LDH is an equal opportunity employer and seeks to recruit a highly productive and diverse workforce and will provide equal employment opportunities to all employees and prospective employees. Employment decisions shall be based strictly on merit and without regard to religious or political beliefs, sex, race, or any other non-merit factor.