Recovery - Coordinator 2

State of Louisiana•Baton Rouge, LA

66d

About The Position

Serves as the subject matter expert in Third-Party Liability (TPL) Recovery issues related to Estate, Trauma, Special Needs Trusts, and/or restitution recoveries. Maintains an advanced working knowledge of Medicaid and Eligibility policy to interpret Medicaid claims. Participates in the development and implementation of TPL policies and procedural changes related to Estate, Trauma, Special Needs Trusts, and/or restitution recoveries. Performs advanced research of claims to identify claims associated with accident-related diagnoses and treatments and/or applicable to various recovery types. Performs advanced calculations to determine appropriate claims recovery amounts and processes incoming payments. Provides support to the Medicaid Fraud and Recovery Investigative Unit's ongoing, statewide operational activities relative to restitution and fraud recoveries. 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; includes issuance of recovery notices and assistance to LDH's Bureau of Legal Service when defending LDH's interest in legal proceedings. May conduct extensive asset, estate, succession, claim, and other necessary case research, potentially involving escalated matters. Serves 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. Makes recommendations for system changes required due to changing federal and/or state regulations, Medicaid policies, and other factors including system modernization efforts. May lead the planning, development, design, testing, and implementation of changes and/or new specifications to the recovery system. May serve as backup to management (i.e. Medicaid Program Supervisor, Medicaid Program Manager 1B). Other tasks as assigned.

Requirements

Bachelor's degree, or Associate's degree plus 3 years of professional experience, or 6 years of professional work experience.
Minimum 1 year professional experience with Medicaid Long Term Care and Home and Community Based Service (HCBS) programs.
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, and verbal/written communications skills.

Nice To Haves

Advanced degree.
Minimum 2 years professional experience with Medicaid Long Term Care and HCBS programs.
Minimum 2 years professional experience with Louisiana Medicaid systems and policy.
Minimum 2 years professional experience with liability insurance claims processing.
Minimum 1 year professional experience with CPT, ICD-9 or ICD-10 coding, and/or HCPCS.

Responsibilities

Serves as the subject matter expert in Third-Party Liability (TPL) Recovery issues related to Estate, Trauma, Special Needs Trusts, and/or restitution recoveries.
Maintains an advanced working knowledge of Medicaid and Eligibility policy to interpret Medicaid claims.
Participates in the development and implementation of TPL policies and procedural changes related to Estate, Trauma, Special Needs Trusts, and/or restitution recoveries.
Performs advanced research of claims to identify claims associated with accident-related diagnoses and treatments and/or applicable to various recovery types.
Performs advanced calculations to determine appropriate claims recovery amounts and processes incoming payments.
Provides support to the Medicaid Fraud and Recovery Investigative Unit's ongoing, statewide operational activities relative to restitution and fraud recoveries.
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; includes issuance of recovery notices and assistance to LDH's Bureau of Legal Service when defending LDH's interest in legal proceedings.
May conduct extensive asset, estate, succession, claim, and other necessary case research, potentially involving escalated matters.
Serves 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.
Makes recommendations for system changes required due to changing federal and/or state regulations, Medicaid policies, and other factors including system modernization efforts.
May lead the planning, development, design, testing, and implementation of changes and/or new specifications to the recovery system.
May serve as backup to management (i.e. Medicaid Program Supervisor, Medicaid Program Manager 1B).
Other tasks as assigned.