Medicaid Program Specialist - Help Members Access Coverage

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

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.