Recovery - Coordinator 1

University of New Orleans•Baton Rouge, LA

9d•$40,000 - $50,000

About The Position

This position may serve as the subject matter expert in Third-Party Liability (TPL) Recovery issues related to Estate, Trauma, Special Needs Trusts, and/or restitution recoveries. The role provides support in responses to escalated matters and develops an advanced working knowledge of Medicaid and Eligibility policy to interpret Medicaid claims. The Coordinator participates in the development and implementation of TPL policies and procedural changes related to Estate, Trauma, Special Needs Trusts, and/or restitution recoveries. Key responsibilities include performing advanced research of claims to identify claims associated with accident-related diagnoses and treatments and/or applicable to various recovery types, and performing advanced calculations to determine appropriate claims recovery amounts and processing incoming payments. The role also provides support to the Medicaid Fraud and Recovery Investigative Unit’s ongoing, statewide operational activities relative to restitution and fraud recoveries. The Coordinator pursues the recovery of funds from third parties (including the estates and Trusts of deceased recipients), as appropriate and according to established policies and procedures; this includes issuing recovery notices and assisting LDH’s Bureau of Legal Service when defending LDH’s interest in legal proceedings. The position may conduct extensive asset, estate, succession, claim, and other necessary case research, requiring regular coordination with LDH’s Bureau of Legal Service, families of deceased Medicaid recipients, attorneys, insurance companies, and other third parties, in the regular management of assigned Recovery caseload. The role may serve as the LDH representative for recovery matters under appeal, including preparation of Summaries of Evidence and other documentation and processes required of the LDH’s and Department of Administrative Law’s fair hearing processes. The Coordinator assists in making recommendations for system changes required due to changing federal and/or state regulations, Medicaid policies, and other factors including system modernization efforts. The role participates in planning, development, design, testing, and implementation of changes and/or new specifications to the recovery system. The position may serve as backup to a team lead (i.e., Recovery Coordinator 2). Other tasks may be assigned as directed.

Requirements

Bachelor’s degree or 6 years’ professional work experience in lieu of degree.
Excellent analytical skills.
Effective organizational and time management skills.
Ability to manage projects, assignments, and competing priorities.
Proficient in the use of Microsoft Office, including but not limited to Outlook, Word, and Excel.
Great attention to detail and follow up.
Verbal/written communications skills.

Nice To Haves

Advanced degree.
Minimum one year of experience in Medicaid Long Term Care and HCBS programs.
Minimum one year of experience with the Louisiana Medicaid systems and policy.
Minimum one year of experience with liability insurance claims processing.
CPT, ICD‐9 or ICD‐10 coding, and HCPCS knowledge.

Responsibilities

Serve as the subject matter expert in Third-Party Liability (TPL) Recovery issues related to Estate, Trauma, Special Needs Trusts, and/or restitution recoveries.
Provide support in responses to escalated matters.
Develop an advanced working knowledge of Medicaid and Eligibility policy to interpret Medicaid claims.
Participate in the development and implementation of TPL policies and procedural changes related to Estate, Trauma, Special Needs Trusts, and/or restitution recoveries.
Perform advanced research of claims to identify claims associated with accident-related diagnoses and treatments and/or applicable to various recovery types.
Perform advanced calculations to determine appropriate claims recovery amounts and process incoming payments.
Provide support to the Medicaid Fraud and Recovery Investigative Unit’s ongoing, statewide operational activities relative to restitution and fraud recoveries.
Pursue the recovery of funds from third parties (including the estates and Trusts of deceased recipients), as appropriate and according to established policies and procedures.
Conduct extensive asset, estate, succession, claim, and other necessary case research.
Coordinate with LDH’s Bureau of Legal Service, families of deceased Medicaid recipients, attorneys, insurance companies, and other third parties in the management of assigned Recovery caseload.
Serve as the LDH representative for recovery matters under appeal, including preparation of Summaries of Evidence and other documentation and processes required of the LDH’s and Department of Administrative Law’s fair hearing processes.
Assist in making recommendations for system changes required due to changing federal and/or state regulations, Medicaid policies, and other factors including system modernization efforts.
Participate in planning, development, design, testing, and implementation of changes and/or new specifications to the recovery system.
Serve as backup to team lead (i.e. Recovery Coordinator 2).
Perform other tasks as directed.