Medicaid Program Monitor

State of Louisiana • Baton Rouge, LA

2d • Onsite

About The Position

The mission of the Louisiana Department of Health is to protect and promote health and to ensure access to medical, preventive, and rehabilitative services for all residents of the State of Louisiana. Join the Louisiana Department of Health’s Medicaid team and play a critical role in protecting program integrity and ensuring eligible individuals receive the benefits they need. In this position, you’ll use your Medicaid expertise to analyze complex federal and state data, investigate eligibility information, and collaborate with staff, policy teams, and legal partners to make informed case decisions. If you’re ready to apply your skills to work that directly impacts the health and well-being of Louisiana residents, we encourage you to apply!

Requirements

• Six years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR Six years of full-time work experience in any field plus three years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR A bachelor’s degree plus three years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR An advanced degree or a Juris Doctorate plus two years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services.
• Every 30 semester hours earned from an accredited college or university will be credited as one year of experience towards the six years of full-time work experience in any field. The maximum substitution allowed is 120 semester hours which substitutes for a maximum of four years of experience in any field.

Responsibilities

• Conducts post-eligibility reviews of Medicaid/LaCHIP eligibility determinations, evaluating financial and non-financial factors for compliance with applicable state and federal requirements.
• Reviews income and other eligibility data from federal and state systems, including Federal Data Services Hub and IRS information, to verify eligibility determinations.
• Documents case findings, corrective actions, policy references, and case activity in appropriate systems and files, and issues required written notifications to applicants and enrollees.
• Updates and maintains eligibility information in the Louisiana Medicaid Eligibility Determination System (LaMEDS), determines current eligibility, and authorizes final eligibility decisions.
• Supports the Centralized Appeal Unit by assisting with fair hearing requests, representing the agency during hearings when needed, and taking appropriate action based on hearing and Administrative Law decisions.
• Interprets and applies complex federal, state, and agency policies and provides assistance with quality control reviews, payment error responses, provider or member inquiries, and eligibility-related complaints.
• Analyzes and reports review findings and trends, notifies management of recurring errors or concerns, and refers appropriate cases to the Medicaid Fraud Unit.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level