Centralized Appeals Unit – Coordinator 1


DEPARTMENT

Medicaid Technical Services Contract


POSITION SUMMARY

(1 Position located in Baton Rouge) Medicaid Services Contract – Centralized Appeals Unit


RESPONSIBILITIES

• Review, analyze, and investigate assigned appeals to determine if the proposed action taken by field staff was accurate based on policy, procedure, and information found within the various Medicaid systems. • Draft and assemble the following documents: appeals cover memoranda; summaries of evidence; agency reversals which will include e‐mails to staff notifying that corrective action needs to be taken and letters to the appellants explaining action taken; withdrawals; and untimely request documents. • Forward the Summary of Evidence, reversal or withdrawal to assigned reviewer, make edits recommended by reviewer. • Upload appeals documents into Medicaid’s Electronic Case Record and upload the documents to the Division of Administrative Law/DHH SharePoint site. Notate the Electronic Case Record indicating that the uploading has been completed and notify the Centralized Appeals Unit’s representative assigned to track the appeal that the necessary documents have been uploaded and mailed to the appellant where applicable. • Monitor the reviewed cases for corrective actions taken by field staff. Determine if all required corrective actions have been taken and email the field staff if further corrective actions are required. • Mail a copy of the Summary of Evidence to the appellant or, if applicable, ensure that a copy of the reversal is mailed to the appellant, and notify the Centralized Appeals Unit’s representative assigned to track the appeal that it has been mailed and notate same in the Electronic Case Record. • Review changes to Medicaid policy and procedures and attend meetings with Medicaid staff as necessary. • Attend telephone and in person hearings, and cover hearings for employees who are not able to attend. • Maintain knowledge of all Medicaid policies and procedures, and ensure that any new changes, updates and/or clearances are applied accordingly. • Other tasks as directed.


REQUIRED QUALIFICATIONS

• Bachelor's degree or 6 years of professional 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.


DESIRED QUALIFICATIONS

• Advanced degree. • Experience with Medicaid appeals. • Knowledge of Medicaid programs, appeals process and eligibility policy. • Minimum 1 year professional experience in health care field, Medicaid eligibility, or Medicaid program support. • Long term care eligibility experience. • HIM, RHIA, RHIT, CHPS, CDI, CHDA or other relevant industry certifications.


SALARY

Commensurate with qualifications and experience.


DATE POSTED

08/31/2017


CLOSING DATE

Position will remain open until filled. To assure full consideration, applications should be received by September 13, 2017.


POSITION NUMBER

8509

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