Medical Certification Specialist 1-2

State of Louisiana•Baton Rouge, LA

2d•Onsite

About The Position

The Louisiana Department of Health’s Office of Aging and Adult Services (OAAS) is hiring a Medical Certification Specialist 1 or 2 to support programs providing long-term care and support services to older adults and individuals with disabilities. The role develops and maintains policies and procedures, coordinates rulemaking, and oversees statewide appeals processes for OAAS Medicaid waiver and state plan programs. It reviews appeals and evidence, coordinates hearings, provides technical assistance, monitors program operations and contractor performance, and supports compliance and quality improvement. The position reports directly to the OAAS Policy Development Level of Care Medical Certification Manager 2. It is based at the Bienville Building in East Baton Rouge Parish and requires in-person work five days per week, Monday through Friday during business hours. Appointment may be probationary or promotional, and selection at Specialist 1 or 2 level depends on the candidate’s qualifications.

Requirements

A current Louisiana license in a health services, health regulation, or social services field plus two years of experience in hospital or nursing home administration, health services, health regulation, or social services; OR a bachelor’s degree plus two years of such experience; OR a master’s degree in a health services, health regulation, or social services field plus one year of such experience.
Work in person at the Bienville Building in East Baton Rouge Parish five days per week, Monday through Friday during business hours.

Nice To Haves

Current interRAI-HC certification from OAAS.
Knowledge of state and federal guidelines, agency policies and procedures, and the Medicaid service system for Long Term Care and Home and Community-Based Services (HCBS).
Knowledge of the appeals process and requirements and timelines for processing appeals.

Responsibilities

Develop, review, and revise policies, procedures, applications, renewals, amendments, and State Plan Amendments for OAAS Medicaid waiver and state plan programs.
Coordinate policy development and rulemaking to ensure compliance with state and federal laws, regulations, and Medicaid requirements.
Administer and oversee statewide appeals processes for OAAS programs, including LT-PCS, CCW, ADHC, and PACE, while meeting established procedures and deadlines.
Review appeal requests, supporting documentation, and evidence; coordinate hearings, resolve issues, and represent OAAS at administrative hearings as needed.
Develop and maintain appeals policies, procedures, manuals, forms, and training materials for consistent statewide implementation.
Provide technical assistance, guidance, and subject matter expertise to OAAS staff, contractors, and stakeholders regarding program requirements, appeals, and compliance.
Monitor appeals activities, contractor performance, service authorizations, and program reports; identify operational issues and recommend corrective actions.
Evaluate program operations, address audit findings, and collaborate with management on policy revisions and quality improvement initiatives.
Oversee program documentation and operating systems to ensure compliance with federal regulations, CMS requirements, and LDH policies.
Prepare reports and recommendations for management and governmental entities and participate in special projects.
Follow applicable LDH, OAAS, Civil Service, state and federal laws, rules, regulations, policies, procedures, and licensing requirements.
Perform other duties assigned by supervisors to support effective agency and OAAS program operations.