U

University of New Orleans

CAU Eligibility Specialist

Regulatory Compliance & EthicsUpdated on Nov 14
Full-timeBaton Rouge, LA, USA$40k - $50kIn-person

About the Job

Requirements

  • A bachelor's degree or six years of professional experience in lieu of a degree is required.
  • Two years of professional experience determining Medicaid eligibility is required.
  • Current working knowledge of the LaMEDS system is required.
  • Analytical skills, organizational and time-management skills, and attention to detail and follow-up are required.
  • Verbal and written communication skills are required.

Responsibilities

  • Complete appeal actions in a timely manner to reopen or close cases according to appeal status, taking precautions not to renotice appellants.
  • Process CAU reversals, including clearing issues and discrepancies in LaMEDS to support application and renewal processing.
  • Review data systems to determine the required action and maintain controls to ensure reversals are completed within required deadlines.
  • Document eligibility research electronically in required Medicaid system applications.
  • Prepare eligibility decision notices by entering required data into the corresponding Medicaid application systems as needed.
  • Maintain knowledge of Medicaid policies and procedures and apply new changes, updates, or clearances.
  • Maintain knowledge and use of all verification systems available to the agency.
  • Interpret and apply complex federal, state, and agency policy, using rudimentary knowledge and terminology of legal, medical, and business areas, including real estate and insurance.
  • Trend and analyze appeals data regionally and statewide, and develop and produce reports based on appeals data to inform training needs and decision-making.
  • Attend and participate in required meetings and trainings.
  • Perform other tasks as directed.

Desired Qualifications

  • A minimum of four years of professional experience determining Medicaid eligibility is desired.
  • A minimum of two years of professional experience working with the Medicaid appeals process is desired.
  • An advanced degree is desired.
  • Advanced knowledge of the LaMEDS system is desired.
  • Experience with data analysis and research is desired.

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