CAU Eligibility Specialist

University of New Orleans•Baton Rouge, LA

2d•$40,000 - $50,000

About The Position

The CAU Eligibility Specialist role at the University of New Orleans involves timely completion of appeal actions to re-open and/or close cases in accordance with appeal status, ensuring appellants are not re-noticed. This position processes CAU reversals, clearing issues and discrepancies in LaMEDS to facilitate application and renewal processing. The specialist will review data systems to determine necessary actions, maintain controls for timely reversal completion, and document eligibility research electronically in Medicaid system applications. Additionally, they will prepare eligibility decision notices, maintain up-to-date knowledge of Medicaid policies and procedures, and utilize all agency-accessible verification systems. The role requires interpreting and applying complex federal, state, and agency policies, employing rudimentary knowledge of legal, medical, and business areas, and analyzing appeals data regionally and statewide to develop reports that inform training needs and decision-making. Participation in required meetings and trainings, along with other directed tasks, is also expected.

Requirements

Bachelor’s degree or 6 years of professional experience in lieu of degree.
2 years of professional experience determining Medicaid eligibility.
Current working knowledge of the LaMEDS system.
Excellent analytical skills, effective organizational and time management skills.
Great attention to detail and follow up.
Excellent verbal and written communication skills.

Nice To Haves

Advanced degree.
Minimum 4 years of professional experience in determining Medicaid eligibility.
Minimum 2 years of professional experience working with Medicaid appeals process.
Advanced knowledge of the LaMEDS system.
Experience with data analysis and research.

Responsibilities

Timely complete appeal actions to re-open and/or close cases in accordance with appeal status.
Take precautions to not re-notice appellants when taking these actions.
Process CAU reversals which will include clearing issues and discrepancies in LaMEDS to assist with the processing of applications and renewals.
Review data systems to determine what action needs to be performed.
Maintain controls to ensure reversals are completed within required deadlines.
Document eligibility research electronically in the required Medicaid system applications.
Prepare eligibility decision notices by inputting required data into the corresponding Medicaid application systems, as necessary.
Maintain knowledge of Medicaid policies and procedures and ensure that any new changes, updates or clearances are applied accordingly.
Maintain knowledge and usage of all verification systems the agency has access to.
Interpret and apply complex federal, state, and agency policy.
Employ rudimentary knowledge and terminology of legal, medical and business areas, including real estate and insurance.
Trend and analyze appeals data both regionally and statewide.
Develop and produce reporting based on appeals data to influence training needs and decision making.
Attend and participate in required meetings and trainings.
Other tasks as directed.