Recovery - Coordinator 1

State of Louisiana; Baton Rouge (LA); On-site; USD 65,000 - 90,000; Full time

Job summary

State of Louisiana, Department of Health in Baton Rouge, seeks a Recovery Specialist to serve as SME in Third-Party Liability (TPL) recovery for Estate, Trauma, Special Needs Trusts and restitution matters.

You will develop advanced knowledge of Medicaid and Eligibility policy to interpret claims, support policy changes, and perform complex research to identify eligible recoveries and calculate recovery amounts.

Qualifications

• Requires a Bachelor’s degree or 6 years of professional experience.
• Strong analytical, organizational and time-management abilities.
• Ability to manage projects and competing priorities.
• Proficiency in Microsoft Office, including Outlook, Word and Excel.
• Excellent verbal and written communication skills.

Responsibilities

• Serve as SME in Third-Party Liability (TPL) recovery related to Estate, Trauma, Special Needs Trusts, and restitution recoveries.
• Develop an advanced working knowledge of Medicaid and Eligibility policy to interpret Medicaid claims.
• Participate in the development and implementation of TPL policies and procedural changes.
• Perform advanced research of claims to identify claims associated with accident-related diagnoses and recoveries.
• Perform advanced calculations to determine appropriate recovery amounts and process incoming payments.
• Provide support to the Medicaid Fraud and Recovery Investigative Unit’s statewide activities.
• Pursue the recovery of funds from third parties including estates and trusts, with guidance from LDH policies.
• May conduct extensive asset, estate, succession research and coordinate with LDH legal services.

Skills

Analytical skills

Organizational skills

Time management

Project management

Verbal/written communications

Attention to detail

Education

Bachelor's degree

Advanced degree

Tools

Microsoft Office

Excel

Word

Outlook

Job description

Job Duties And Other Information

• May serve as the subject matter expert in Third-Party Liability (TPL) Recovery issues related to Estate, Trauma, Special Needs Trusts, and/or restitution recoveries. Provides support in responses to escalated matters.
• Develops an advanced working knowledge of Medicaid and Eligibility policy to interpret Medicaid claims.
• Participates in the development and implementation of TPL policies and procedural changes related to Estate, Trauma, Special Needs Trusts, and/or restitution recoveries.
• Performs advanced research of claims to identify claims associated with accident-related diagnoses and treatments and/or applicable to various recovery types.
• Performs advanced calculations to determine appropriate claims recovery amounts and processes incoming payments.
• Provides support to the Medicaid Fraud and Recovery Investigative Unit’s ongoing, statewide operational activities relative to restitution and fraud recoveries.
• Pursues the recovery of funds from third parties (including the estates and Trusts of deceased recipients), as appropriate and according to established policies and procedures; includes issuance of recovery notices and assistance to LDH’s Bureau of Legal Service when defending LDH’s interest in legal proceedings.
• May conduct extensive asset, estate, succession, claim, and other necessary case research. Requires regular coordination with LDH’s Bureau of Legal Service, families of deceased Medicaid recipients, attorneys, insurance companies, and other third parties, in the regular management of assigned Recovery caseload.
• May serve as the LDH representative for recovery matters under appeal, including preparation of Summaries of Evidence and other documentation and processes required of the LDH’s and Department of Administrative Law’s fair hearing processes.
• Assists in making recommendations for system changes required due to changing federal and/or state regulations, Medicaid policies, and other factors including system modernization efforts.
• Participates in planning, development, design, testing, and implementation of changes and/or new specifications to the recovery system.
• May serve as backup to team lead (i.e. Recovery Coordinator 2).
• Other tasks, as directed.

Required Qualifications

• Bachelor’s degree or 6 years’ professional work experience in lieu of degree.
• Excellent analytical skills, effective organizational and time management skills.
• Ability to manage projects, assignments, and competing priorities.
• Proficient in the use of Microsoft Office, including but not limited to Outlook, Word, and Excel.
• Great attention to detail and follow up, and verbal/written communications skills.

Desired Qualifications

• Advanced degree.
• Minimum one year of experience in Medicaid Long Term Care and HCBS programs.
• Minimum one year of experience with the Louisiana Medicaid systems and policy.
• Minimum one year of experience with liability insurance claims processing.
• CPT, ICD-9 or ICD-10 coding, and HCPCS knowledge.

Benefits for unclassified employees are determined by the individual hiring authority.