Claims Processing – Coordinator 1


Medicaid Technical Services Contract


1 Position located in Baton Rouge


• Responsible for maintenance and update of the recipient subsystem in the highly complex and specialized Claims Processing/Claims Resolution Unit • Independently review, monitor, analyze and evaluate complex programmatic reports generated by the Fiscal Intermediary. • Responsible for making project recommendations based on report findings. • Responsible for resolving daily Medicaid, QMB, LTC/Waiver discrepancies identified in the daily error/activity reports, ad-hoc reports and quarterly reconciliation reports created from the MEDS/MMIS interface. • Assists in designing system changes to assure the accurate and timely adjudication of claims; and initiates design changes to the recipient sub-system to maintain the integrity of the electronic claims processing system. • Reviews and evaluates preliminary and acceptance testing for design changes to the recipient sub-system and other files associated with the system. • Monitors the MEVS/REVS systems and reports discrepancies or make project recommendations as needed. • Resolves out of state billing problems based on Medicaid billing practices. • Consults daily with providers, provider representatives, enrollees, insurance companies, and collection agencies, serving as a liaison in assisting with claims adjudication problems. • Researches relevant information from the enrollees, providers, LDH Staff, FI Staff, policy and procedure manuals, and various MMIS subsystems in order to facilitate proper claims adjudication. • Answer and return calls from MMIS main number and the Retroactive Reimbursement hotline. • Process Recipient Reimbursement request as needed • Assists higher level Managers with special projects and/or other duties as assigned.


• 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. • Ability to manage projects, assignments, and competing priorities. • Proficient in the use of Microsoft Office, including but not limited to Outlook, Word, and Excel.


• Advanced degree. • Minimum 1 year of professional experience with Medicaid. • Minimum 1 year of experience with MMIS mainframe system and MEDS system. • Experience in healthcare billing. • CPT, ICD-9 or ICD­10 coding and HCPCS knowledge. • CHDA, HIM, RHIA, RHIT, CCA, CMA, CPA, CIA, CGAP, HFMA or other relevant industry certifications.


Commensurate with qualifications and experience.







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