OAAS LT-PCS Appeals – Coordinator 1


DEPARTMENT

Medicaid Technical Services Contract


POSITION SUMMARY

(1 Position located in Baton Rouge)


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. • 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 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 directed.


REQUIRED QUALIFICATIONS

• Bachelor’s Degree or 6 years’ professional work experience in lieu of degree. • Two years of professional level experience in administrative services, economics, public health, public relations, or in providing social services or health services • 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. • Knowledge of Louisiana's Office of Aging and Adult Services (OAAS) Long Term- Personal Care Services (LT-PCS) policies and procedures. • Minimum 1 year of experience with any of the following: • Telesys Database. • Long Term- Personal Care Service (LT- PCS). • Level of Care (LOC) Determinations, Minimum Data Set for Home Care (MDS-HC) and/or Plan of Care (POC) quality review tool. • Professional experience in health care field, appeals, or LTC program support. • Relevant industry certifications


SALARY

Commensurate with qualifications and experience.


DATE POSTED

05/31/2018


CLOSING DATE

Position will remain open until filled.


POSITION NUMBER

8995

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