OAAS Appeals - Coordinator 1

State of Louisiana; Baton Rouge (LA); On-site; USD 42,000 - 62,000; Full time

Job summary

State of Louisiana invites applications for an appeals processing role in Baton Rouge. The position handles appeal notices, creates and maintains files, reviews submissions, and requests decision letters, while coordinating with LDH staff and DAL personnel.

Responsibilities include preparing evidence summaries, uploading SOE packets to SharePoint, tracking decisions, and conducting hearings. Interaction with agencies, legislators, and the public is required.

Responsibilities

• Receive appeal notices and updates, create files for new appeals received, and maintain files appropriately.
• Review new appeals for the adverse action, reason for appeal, and timeliness of submission.
• Request Decision/Denial letters on new appeals received.
• Research data materials to accumulate evidence, prepare summary of evidence (SOE) packets, upload final SOE packets to the Division of Administrative Law SharePoint site, and download rendered decision from appeal hearings via SharePoint.
• Coordinate with responsible parties, such as other LDH appeal staff, the Division of Administrative Law (DAL) personnel, and the designated contracted agencies.
• Enter all of the initial data into the Appeals Log once the file has been reviewed, and update the appeals log as needed for each case throughout the entire appeals process.
• Schedule appeal hearings and represent LDH by presentation of evidence during appeal hearings.
• Extend and follow up on Prior Authorization for appeals with existing services.
• Update the electronic file with decisions.
• Monitor and analyze reports and evaluate monitored findings relative to level of care eligibility and other programmatic policy in Office of Aging and Adult Services (OAAS) programs.
• Meet with various LDH staff and contracted consultants as needs arise, and respond to routine, verbal, and written inquiries from agencies, legislators, government officials, general public, and participants as directed by supervisor.
• Plan and/or conduct/assist with staff meetings, conferences, and assist with training for staff, self-advocates, and providers.
• Provide systems data to supervisor as needed for analytical reports, and participate in implementation of special programs, projects, and the collection of data for special projects and reports.
• Other tasks as assigned.

Job description

• Receive appeal notices and updates, create files for new appeals received, and maintain files appropriately.
• Review new appeals for the adverse action, reason for appeal, and timeliness of submission.
• Request Decision/Denial letters on new appeals received.
• Research data materials to accumulate evidence, prepare summary of evidence (SOE) packets, upload final SOE packets to the Division of Administrative Law SharePoint site, and download rendered decision from appeal hearings via SharePoint.
• Coordinate with responsible parties, such as other LDH appeal staff, the Division of Administrative Law (DAL) personnel, and the designated contracted agencies.
• Enter all of the initial data into the Appeals Log once the file has been reviewed, and update the appeals log as needed for each case throughout the entire appeals process.
• Schedule appeal hearings and represent LDH by presentation of evidence during appeal hearings.
• Extend and follow up on Prior Authorization for appeals with existing services.
• Update the electronic file with decisions.
• Monitor and analyze reports and evaluate monitored findings relative to level of care eligibility and other programmatic policy in Office of Aging and Adult Services (OAAS) programs.
• Meet with various LDH staff and contracted consultants as needs arise, and respond to routine, verbal, and written inquiries from agencies, legislators, government officials, general public, and participants as directed by supervisor.
• Plan and/or conduct/assist with staff meetings, conferences, and assist with training for staff, self-advocates, and providers.
• Provide systems data to supervisor as needed for analytical reports, and participate in implementation of special programs, projects, and the collection of data for special projects and reports.
• Other tasks as assigned.