OAAS Appeals - Coordinator 1

LSU New Orleans; New Orleans (LA); On-site; USD 37,000 - 47,000; Full time

Job summary

LSU New Orleans seeks a detail-oriented Program Integrity professional to manage appeal case files, review submissions, and coordinate with LDH staff, DAL, and contracted agencies. You will prepare SOE packets, upload to SharePoint, and track data through the appeals process with regular updates.

Qualifications include a Bachelor’s or equivalent, strong analytical and organizational skills, and proficiency in Microsoft Office. The role requires on-site work in Louisiana.

Qualifications

• 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.

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.

Education

Bachelor’s degree, or Associate’s degree plus 3 years of professional experience, or 6 years of professional work experience

Tools

Microsoft Office Suite (Outlook, Word, Excel)

Job description

Department Program Integrity Job Summary 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.

QUALIFICATIONS REQUIRED

• 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

37-47k

Posting Close Date

This position will remain open until filled.

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.