Centralized Appeals Unit - Coordinator 1

University of New Orleans•Baton Rouge, LA

1d•$43,000 - $53,000

About The Position

This position involves reviewing, analyzing, and investigating assigned appeals to determine the accuracy of actions taken by field staff based on policy, procedure, and information within Medicaid systems. The role requires drafting and assembling various documents, including appeals cover memoranda, summaries of evidence, agency reversals, withdrawals, and untimely request documents. Responsibilities also include uploading documents to electronic case records and SharePoint sites, monitoring cases for corrective actions, and ensuring timely communication with appellants and field staff. The position requires staying updated on Medicaid policies and procedures, attending meetings, and potentially attending or covering hearings. Other tasks as directed are also part of the role.

Requirements

Bachelor's degree, or an Associate's degree plus three years of professional experience, or six years of professional experience in lieu of degree.
Excellent analytical skills.
Effective organizational and time management skills.
Great attention to detail and follow up.
Verbal/written communications skills.
Ability to work well both independently and as part of a team.
Ability to set, follow, and meet deadlines.
Proficient in the use of Adobe Acrobat Pro as well as Microsoft Office Suite (Word, Excel, PowerPoint, and Outlook).

Nice To Haves

Advanced degree.
Minimum one year of professional experience with Medicaid appeals processes and procedures.
Minimum one year professional experience with Medicaid eligibility including MAGI, Non-MAGI, Long Term Care and HCBW programs.
Minimum one year of professional experience working in the Medicaid eligibility system LaMEDS.
Industry-related certifications such as HIM, RHIA, RHIT, CDI, CHDA.

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 appeals cover memoranda, summaries of evidence, agency reversals (including emails to staff and letters to appellants), withdrawals, and untimely request documents.
Forward the Summary of Evidence, reversal, or withdrawal to the assigned reviewer and make recommended edits.
Upload appeals documents into Medicaid’s Electronic Case Record and to the Division of Administrative Law/LDH SharePoint site.
Notate Case Notes indicating that uploading has been completed and notify the Centralized Appeals Unit's representative that documents have been uploaded and mailed to the appellant where applicable.
Monitor reviewed cases for corrective actions taken by field staff and email field staff if further corrective actions are required.
Mail a copy of the Summary of Evidence or reversal to the appellant and notify the Centralized Appeals Unit's representative that it has been mailed, notating this in the Electronic Case Record.
Review changes to Medicaid policy and procedures and attend meetings with Medicaid staff as necessary.
Attend telephone and in-person hearings, and cover hearings for employees who are not able to attend.
Maintain knowledge of all Medicaid policies and procedures, and ensure that any new changes, updates, and/or clearances are applied accordingly.
Perform other tasks as directed.