Medicaid TPL & Benefits Analyst — Claims & Compliance

LSU New Orleans; New Orleans (LA); On-site; USD 60,000 - 70,000; Full time

Job summary

The University of New Orleans is seeking a TPL Coordinator to respond to provider, health plan, and member inquiries, coordinating benefits between Medicaid and other primary insurance sources.

The role investigates billing issues, supports Medicare/TPL billing, helps develop policies, and ensures contract language is followed.

You will work with LDH, MCOs, and providers to monitor performance, prepare advisories, and keep TPL plans current.

Qualifications

• Bachelor’s degree or 6 years’ professional experience in lieu of degree.
• Minimum 2 years of professional experience working with Medicare and/or private insurance claims.
• Excellent analytical, organizational, communication and time management skills.
• Strong verbal and written communications skills and ability to communicate technical concepts to technical and nontechnical audiences.
• Great attention to detail and follow up.

Responsibilities

• Coordinate benefits between Medicaid and other primary insurance sources.
• Investigate billing and payment issues including denied claims.
• Assist with Medicare/TPL billing and related policies.
• Develop and implement TPL policies and procedural changes.
• Create and maintain health plan advisories and informational bulletins.
• Monitor TPL administration and contract deliverables.
• Assist with RFPs and contract negotiations.
• Report TPL KPIs and quarterly financials.
• Communicate with providers, members, Medicaid staff, contractors, and third party insurers.

Skills

Analytical skills

Organizational skills

Communication skills

Time management

Education

Bachelor’s degree or 6 years’ experience in lieu of degree

Tools

CPT/ICD-10/HCPCS

Job description

The University of New Orleans is seeking a TPL Coordinator to respond to provider, health plan, and member inquiries, coordinating benefits between Medicaid and other primary insurance sources.

The role investigates billing issues, supports Medicare/TPL billing, helps develop policies, and ensures contract language is followed.

You will work with LDH, MCOs, and providers to monitor performance, prepare advisories, and keep TPL plans current.