Department Quality Control

Job Summary

Job Description

• 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.

QUALIFICATIONS

REQUIRED:

• 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.

DESIRED:

• 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.

Required Attachments Please upload the following documents in the Resume/Cover Letter section.

• Detailed resume listing relevant qualifications and experience;
• Cover Letter indicating why you are a good fit for the position and University of Louisiana Systems;
• Names and contact information of three references; Applications that do not include the required uploaded documents may not be considered.

Posting Close Date

This position will remain open until filled. Note to Applicant: Applicants should fully describe their qualifications and experience with specific reference to each of the minimum and preferred qualifications in their cover letter. The search committee will use this information during the initial review of application materials. References will be contacted at the appropriate phase of the recruitment process. This position may require a criminal background check to be conducted on the candidate(s) selected for hire. As part of the hiring process, applicants for positions at the University of New Orleans may be required to demonstrate the ability to perform job-related tasks. The University of New Orleans is an Affirmative Action and Equal Employment Opportunity employer. We do not discriminate on the basis of race, gender, color, religion, national origin, disability, sexual orientation, gender identity, protected Veteran status, age if 40 or older, or any other characteristic protected by federal, state, or local law.