Centralized Appeals Unit - Coordinator 2

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Department

CAU State Office 2

Job Summary

Job Description

• Review, analyze, and investigate assigned appeals to determine if the proposed action taken by field staff was accurate based on policy, procedure, and information found within the various Medicaid systems.
• Draft and assemble the following documents : appeals cover memoranda; summaries of evidence; agency reversals which will include e-mails to staff notifying that a corrective action needs to be taken and letters to the appellants explaining the action taken; withdrawals; and untimely request documents.
• Forward the Summary of Evidence, reversal or withdrawal to assigned reviewer, make edits recommended by reviewer.
• Upload appeals documents into Medicaid's Electronic Case Record and upload the documents to the Division of Administrative Law / LDH SharePoint site. Notate the Case Notes indicating that the uploading has been completed and notify the Centralized Appeals Unit's representative assigned to track the appeal that the necessary documents have been uploaded and mailed to the appellant where applicable.
• Monitor the reviewed cases for corrective actions taken by field staff. Determine if all required corrective actions have been taken and email the field staff if further corrective actions are required.
• Mail a copy of the Summary of Evidence to the appellant or, if applicable, ensure that a copy of the reversal is mailed to the appellant, and notify the Centralized Appeals Unit's representative assigned to track the appeal that it has been mailed and notate same in the Electronic Case Record.
• Review changes to Medicaid policy and procedures and attend meetings with Medicaid staff as necessary.
• Attend telephone and in person hearings, and cover hearings for employees who are not able to attend.
• Maintain knowledge of all Medicaid policies and procedures, and ensure that any new changes, updates and / or clearances are applied accordingly.
• Processes Long Term Care Appeals and following all the processes and procedures for Medicaid appeals.
• Conducts 1 : 1 training with assigned staff on Long Term Care policy, procedures and guidance's issued by LDH Policy section.
• Maintain updates to policies, procedures, and appeals training manual; disseminate any changes to employees.
• Other tasks as directed.

QUALIFICATIONS

REQUIRED :

DESIRED :

Required Attachments

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

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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.