Quality Control - Coordinator 1

University of New Orleans•Baton Rouge, LA

About The Position

Reviews 20 to 40 assigned eligibility cases monthly for compliance with policy and procedure, using documentation found within various Medicaid systems and data sources. Further investigation using external information may sometimes be required. Interprets and applies Medicaid and CHIP eligibility policies, procedures, rules and regulations. Makes determination of the correctness of the agency's eligibility decision to approve or deny the specific category of Medicaid or CHIP coverage. Identifies deficiencies in systems documentation relative to review elements such as income, household, resources, citizenship, etc. Maintains high degree of knowledge relative to changes to Medicaid policy and procedures. Maintains high degree of proficiency navigating Louisiana’s Medicaid eligibility determination system. Generates and maintains detailed and organized audit documentation and exhibits, such as screenshots, third party data, copies of policies, etc. Completes special projects as assigned by the Louisiana Department of Health (LDH). Monitors eligibility cases for corrective actions made by the Eligibility Program. Attends meetings with Medicaid staff. Assists with the development of systems and applications utilized by LDH to capture case review information electronically for reporting and statistical computations. Other tasks as assigned.

Requirements

Bachelor’s Degree, or Associates degree with 3 years professional experience, or 6 years professional experience in lieu of degree
Minimum 1 year professional experience working with Medicaid/CHIP programs
Knowledge of eligibility requirements and/or procedures relative to state medical coverage programs
Excellent analytical skills, effective organizational and time management skills
Great attention to detail and follow up
Ability to manage projects, assignments, and competing priorities
Proficient in the use of Microsoft Office, including but not limited to Outlook, Word, and Excel

Nice To Haves

Advanced degree
Minimum 2 years professional experience working with Medicaid/CHIP programs
Minimum 1 year professional experience working Medicaid/CHIP eligibility cases
Minimum 1 year professional experience with auditing
Relevant industry certifications

Responsibilities

Reviews 20 to 40 assigned eligibility cases monthly for compliance with policy and procedure
Interprets and applies Medicaid and CHIP eligibility policies, procedures, rules and regulations
Makes determination of the correctness of the agency's eligibility decision to approve or deny the specific category of Medicaid or CHIP coverage
Identifies deficiencies in systems documentation relative to review elements such as income, household, resources, citizenship, etc.
Maintains high degree of knowledge relative to changes to Medicaid policy and procedures
Maintains high degree of proficiency navigating Louisiana’s Medicaid eligibility determination system
Generates and maintains detailed and organized audit documentation and exhibits, such as screenshots, third party data, copies of policies, etc.
Completes special projects as assigned by the Louisiana Department of Health (LDH)
Monitors eligibility cases for corrective actions made by the Eligibility Program
Attends meetings with Medicaid staff
Assists with the development of systems and applications utilized by LDH to capture case review information electronically for reporting and statistical computations
Other tasks as assigned