Status: Full-time

Department: Medicaid Services Contract – MMIS

Posted: Thursday, December 10, 2020

Salary: Commensurate with qualifications and experience.

Job ID: 9377

Position Summary

1 positions located in Baton Rouge

Responsibilities

• Serves as subject matter expert in Third-Party Liability (TPL) Recovery issues related to Estate, Trauma, Special Needs Trusts, and/or restitution recoveries.
• Maintains an advanced working knowledge of Medicaid and Eligibility policy to interpret Medicaid claims.
• Participates in the development and implementation of TPL policies and procedural changes related to Estate, Trauma, Special Needs Trusts, and/or restitution recoveries. 
• Performs advanced research of claims to identify claims associated with accident-related diagnoses and treatments and/or applicable to various recovery types.
• Performs advanced calculations to determine appropriate claims recovery amounts and processes incoming payments.
• Provides support to the Medicaid Fraud and Recovery Investigative Unit’s ongoing, statewide operational activities relative to restitution and fraud recoveries.
• Pursues the recovery of funds from third parties (including the estates and Trusts of deceased recipients), as appropriate and according to established policies and procedures; includes issuance of recovery notices and assistance to LDH’s Bureau of Legal Service when defending LDH’s interest in legal proceedings.
• Serves as LDH representative for recovery matters under appeal, including preparation of Summaries of Evidence and other documentation and processes required of the LDH’s and Department of Administrative Law’s fair hearing processes.
• Makes recommendations for system changes required due to changing federal and/or state regulations, Medicaid policies, and other factors including system modernization efforts.
• Participates in planning, development, design, testing, and implementation of changes and/or new specifications to the recovery system.
• Other tasks, as directed.

Required Qualifications

• Bachelor’s degree or 6 years’ professional work experience in lieu of degree.
• Minimum one year of professional work experience.
• 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.
• Minimum one year of professional work experience in healthcare field.
• Knowledge of Louisiana Medicaid systems and policy.
• Experience in liability insurance claims processing.
• Experience in Medicaid Long Term Care and HBCS programs.
• CPT, ICD‐9 or ICD‐10 coding, and HCPCS knowledge.

Closing Date

Position will remain open until filled.