Quality Control – Coordinator 1


Medicaid Technical Services Contract


(1 Position located in Baton Rouge)


• Review, analyze, and investigate assigned eligibility cases to determine their validity and accuracy based on policy, procedure, and information found within the various Medicaid systems. • Complete special eligibility quality control research projects as assigned by LDH. • Transfer cases into the Medicaid’s Electronic Case Record and distribute copies of the case review into the appropriate shared drives/folders. • Email the appropriate parishes when corrective action is required on a case review and log findings. Incumbent may also be required to follow up with different types of third party institutions as part of the audit process to validate information or follow‐up on information that is unclear or incomplete and prepare in‐ depth written case review analyses and reports. • Monitor the reviewed cases for corrective actions taken by the parishes and checks for email responses from the parish offices. Determine if all required corrective actions have been taken and email the parish offices if further corrective actions are required. • Assist the Department in establishing training needs for staff in an effort to reduce errors and increase the quality of Medicaid certifications. • Review changes to Medicaid policy and procedures and attend meetings with Medicaid staff. • Serve as backup to other Quality Control employees. • Work with LDH in identifying reporting/statistical needs in relation to Medicaid eligibility quality control review of cases. • Gather quantifiable information from cases completed and compile statistical data on the Medicaid Eligibility Quality Control and PERM reviews performed by the unit. • Assemble charts and diagrams with the statistical information and provide visual charts to depict results of case reviews of special projects and pilots as assigned. • Assist with the development of the systems and applications utilized by the department to capture the necessary information electronically to be used for statistical computations. • Other tasks as directed.


• Bachelor’s Degree or 6 years’ professional work experience in lieu of degree. • Excellent analytical skills, effective organizational and time management skills. • Great attention to detail and follow up, and verbal/written communications skills.


• Advanced degree. • Knowledge of Medicaid/CHIP programs and eligibility policy. • Professional experience in health care field, Medicaid/CHIP eligibility or Medicaid program support. • Minimum 1 year of professional experience working Medicaid/CHIP eligibility cases. • Minimum 1 year of experience with system/application design or development. • Minimum 1 year of experience with data analysis or compiling statistical data. • HIM, RHIA, RHIT, CHPS, CDI, CHDA or other relevant industry certifications.


Commensurate with qualifications and experience.




Position will remain open until filled.




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