Centralized Appeals Unit - Coordinator 2

2 Positions Located in Baton Rouge
This position is open to current UNO employees only

POSITION #: 8875, 8876

DEPARTMENT: Medicaid Technical Services Contract – Eligibility Support

CORE 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.
  • Oversee and assist subordinates with appeals questions and/or issues that arise.
  • Review subordinates’ SOEs, Reversals, Dismissals and Untimely submissions. Draft emails summarizing actions taken on all Reversed decisions and propose future preventative measures for the department.
  • Send daily email notifications of appeal assignments, ensure that assignments are completed within set deadlines, make sure that all hearings are covered and manage the unit’s email correspondence with the local Medicaid offices.
  • Maintain updates to policies, procedures, and appeals training manual; disseminate any changes to employees.
  • Assist the supervisor in the compilation of appeals statistics and monthly reports.
  • Conduct an annual performance evaluation for each subordinate, setting future goals and strategies.
  • Conduct recruitment, selection, training, supervision, and professional development of assigned staff.
  • Other tasks as directed..

REQUIRED QUALIFICATIONS:

  • Bachelor's degree or 8 years of professional experience in lieu of degree.
  • Excellent analytical skills, effective organizational and time management skills.
  • Minimum 2 year of professional experience in health care field, Medicaid eligibility or Medicaid program support.   
  • Minimum 1 year of experience working with Medicaid appeals.
  • Great attention to detail and follow up, and verbal/written communications skills.

DESIRED QUALIFICATIONS:

  • Advanced degree.
  • Supervisory experience.
  • Minimum 3 year of professional experience in health care field, Medicaid eligibility or Medicaid program support
  • Minimum 2 years of experience working with Medicaid appeals.
  • HIM, RHIA, RHIT, CHPS, CDI, CHDA or other relevant industry certifications.

SALARY: Commensurate with qualifications and experience.

APPLICATION PROCEDURE: Applicants should submit a cover letter, resume (including salary requirement), a copy of transcripts (if applicable), and 3 letters of reference to Kit Keophommavong at UNO.Jobs@LA.gov with the job title in the email subject line.

DATE POSTED: June 12, 2014

CLOSING DATE: To assure full consideration, applications should be received by June 18, 2014. Review of applications in progress; positions will remain open until filled.

All applicants will be considered for employment without regard to retirement status and without regard to an applicant’s having previously accused the UL System Board of its universities of unlawful discrimination. Retirement status shall not be considered in the hiring process by any University in the UL System.

The University of New Orleans is an Affirmative Action/Equal Employment Opportunity employer. Women, ethnic minorities, veterans and persons with disabilities are encouraged to apply.