MEDICAID PROGRAM SPECIALIST 2

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 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

Join the Louisiana Department of Health’s Medicaid Eligibility Quality team and help ensure eligible Louisianans receive the healthcare coverage they need. As a Medicaid Program Specialist 2, you’ll review complex eligibility cases, resolve discrepancies, support appeals, and help ensure accurate, timely decisions in accordance with Medicaid policy and federal requirements. If you’re detail-oriented, analytical, and passionate about improving access to essential healthcare services.

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.
• Demonstrating Accountability: The ability to take ownership of actions, behaviors, performance, decisions, and outcomes.
• Thinking Critically: The ability to analyze information objectively, identify connections across sources, and form logical, well supported conclusions.
• 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.
• 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.
• The official job specifications for this role, as defined by the State Civil Service, can be found here.

Job Duties:

• 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.

Position-Specific Details:

• Location: Medical Vendor Administration / Eligibility Program Operations / East Baton Rouge Parish
• Appointment Type: Probational or Job Appointment (temporary appointment that may last up to 48 months),
• Cost Center: 305-2050401
• Position Number(s): 50661286

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.