OAAS Appeals - Coordinator 1

University of New Orleans•Baton Rouge, LA

3d•$37,000 - $47,000

About The Position

This position is within the Program Integrity department and is responsible for managing the appeals process for the Office of Aging and Adult Services (OAAS). The role involves receiving and processing appeal notices, reviewing appeals for accuracy and timeliness, requesting decision letters, researching data, preparing and uploading evidence summary packets, and coordinating with various stakeholders. The Coordinator will also maintain the Appeals Log, schedule hearings, represent LDH in hearings, manage prior authorizations, update electronic files with decisions, and monitor reports related to program eligibility. Additionally, the role involves meeting with staff, responding to inquiries, assisting with staff meetings and training, and providing data for reports and special projects.

Requirements

Bachelor’s degree, or Associate’s degree plus 3 years of professional experience, or 6 years of professional work experience.
Excellent analytical skills, effective organizational and time management skills.
Excellent verbal and written communications skills.
Proficient in the use of Microsoft Office, including but not limited to Outlook, Word, and Excel.

Nice To Haves

Advanced degree.
Minimum 1 year of professional experience in health care field, appeals, or LTC program support.
Minimum 1 year of professional experience working with Louisiana's Office of Aging and Adult Services (OAAS) Long Term- Personal Care Services (LT-PCS) policies and procedures.
Minimum 1 year of professional experience working with Nursing Facility Level of Care (NFLOC) Determinations and assessment tools.
Relevant industry certifications.

Responsibilities

Receive appeal notices and updates, create files for new appeals received, and maintain files appropriately.
Review new appeals for the adverse action, reason for appeal, and timeliness of submission.
Request Decision/Denial letters on new appeals received.
Research data materials to accumulate evidence, prepare summary of evidence (SOE) packets, upload final SOE packets to the Division of Administrative Law SharePoint site, and download rendered decision from appeal hearings via SharePoint.
Coordinate with responsible parties, such as other LDH appeal staff, the Division of Administrative Law (DAL) personnel, and the designated contracted agencies.
Enter all of the initial data into the Appeals Log once the file has been reviewed, and update the appeals log as needed for each case throughout the entire appeals process.
Schedule appeal hearings and represent LDH by presentation of evidence during appeal hearings.
Extend and follow up on Prior Authorization for appeals with existing services.
Update the electronic file with decisions.
Monitor and analyze reports and evaluate monitored findings relative to level of care eligibility and other programmatic policy in Office of Aging and Adult Services (OAAS) programs.
Meet with various LDH staff and contracted consultants as needs arise, and respond to routine, verbal, and written inquiries from agencies, legislators, government officials, general public, and participants as directed by supervisor.
Plan and/or conduct/assist with staff meetings, conferences, and assist with training for staff, self-advocates, and providers.
Provide systems data to supervisor as needed for analytical reports, and participate in implementation of special programs, projects, and the collection of data for special projects and reports.
Other tasks as assigned.