OAAS Appeals - Coordinator 1

University of New Orleans; Baton Rouge (LA); On-site; USD 37,000 - 47,000; Full time

Job summary

LSU New Orleans seeks a Program Integrity specialist to manage appeal processes, create and maintain case files, and coordinate hearings. You will prepare evidence summaries and collaborate with LDH staff and contracted agencies to ensure timely decisions.

The role requires a Bachelor’s degree or equivalent experience; an advanced degree is preferred. Health care or LT-PCS policy exposure is beneficial. Strong analytical and communication skills are essential for success.

Qualifications

• Bachelor’s degree or Associate degree with professional experience (see minimum qualifications).
• Advanced degree preferred.
• Experience in health care, appeals, or LT-PCS policies helpful.

Responsibilities

• Receive and process appeal notices; create and maintain files.
• Review adverse action, appeal reason, and submission timeliness.
• Prepare SOE packets and upload to SharePoint.
• Coordinate with LDH staff, DAL personnel, and contracted agencies.
• Enter data into Appeals Log and update throughout the process.
• Schedule hearings and represent LDH with evidence presentation.
• Monitor programs and evaluate eligibility guidance.
• Respond to inquiries from agencies, legislators, and the public.

Skills

Analytical skills

Organizational skills

Time management

Communication skills

Education

Bachelor's degree

Associate degree + 3 years experience

Advanced degree (desired)

Tools

Microsoft Office (Outlook Word Excel)

Job description

Thank you for your interest in LSU New Orleans.Once you start the application process, you will not be able to save your work, so you should collect all required information before you begin. The required information is listed below in the job posting.You must complete all required portions of the application and attach the required documents in order to be considered for employment.DepartmentProgram IntegrityJob SummaryJob DescriptionReceive 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.QUALIFICATIONSREQUIRED:Bachelor’s degree, or Associate’s degree plus 3 years of professional experience, or 6 years of professional work experience.Excellent analytical skills, effective organizational and time management skills.Excellent verbal and written communications skills.Proficient in the use of Microsoft Office, including but not limited to Outlook, Word, and Excel.DESIRED:Advanced degree.Minimum 1 year of professional experience in health care field, appeals, or LTC program support.Minimum 1 year of professional experience working with Louisiana's Office of Aging and Adult Services (OAAS) Long Term- Personal Care Services (LT-PCS) policies and procedures.Minimum 1 year of professional experience working with Nursing Facility Level of Care (NFLOC) Determinations and assessment tools.Relevant industry certifications.SALARY: 37-47kRequired AttachmentsPlease upload the following documents in the Resume/Cover Letter section.Detailed resume listing relevant qualifications and experience;Cover Letter indicating why you are a good fit for the position and LSU New Orleans;Names and contact information of three references;Applications that do not include the required uploaded documents may not be considered.Posting Close DateThis position will remain open until filled.Note to Applicant:Applicants should fully describe their qualifications and experience with specific reference to each of the minimum and preferred qualifications in their cover letter. The search committee will use this information during the initial review of application materials.References will be contacted at the appropriate phase of the recruitment process.This position may require a criminal background check to be conducted on the candidate(s) selected for hire.As part of the hiring process, applicants for positions at LSU New Orleans may be required to demonstrate the ability to perform job-related tasks.LSU New Orleans seeks to recruit a highly productive 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.