Recovery - Coordinator 1

University of New Orleans•Baton Rouge, LA

1d•$40,000 - $50,000

About The Position

This position serves as a subject matter expert in Third-Party Liability (TPL) Recovery issues, focusing on Estate, Trauma, Special Needs Trusts, and restitution recoveries. The role involves supporting escalated matters, developing a deep understanding of Medicaid and Eligibility policy to interpret claims, and participating in the development and implementation of TPL policies and procedural changes. Key responsibilities include performing advanced research to identify accident-related claims and applicable recovery types, calculating recovery amounts, processing payments, and supporting the Medicaid Fraud and Recovery Investigative Unit. The role also involves pursuing fund recovery from third parties, including estates and trusts of deceased recipients, issuing recovery notices, and assisting the Bureau of Legal Services in legal proceedings. Extensive research of assets, estates, successions, and claims may be required. The position necessitates regular coordination with the Bureau of Legal Services, families of deceased recipients, attorneys, insurance companies, and other third parties. It may also involve representing the LDH in recovery matters under appeal, preparing necessary documentation for fair hearings, and assisting in recommendations for system changes due to regulatory updates or modernization efforts. Participation in the planning, development, testing, and implementation of recovery system changes is also expected. The role may serve as backup to the team lead (Recovery Coordinator 2) and perform other directed tasks.

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; includes issuance of recovery notices and assistance to LDH’s Bureau of Legal Service when defending LDH’s interest in legal proceedings.
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.