Communicating Effectively:

The ability to convey information, ideas, and emotions using structured communication methods that promote understanding and engagement.

Making Accurate Judgments:

The ability to assess options, weigh risks, and make sound decisions using available information and logical reasoning

Thinking Critically:

The ability to analyze information objectively, identify connections across sources, and form logical, well supported conclusions.

Acting Decisively :

The ability to make timely, confident decisions using sound reason. Adapting to

Change :

The ability to demonstrate flexibility in thoughts, behaviors, and actions in response to evolving circumstances or unexpected change.

Displaying Professionalism:

The ability to uphold workplace standards through consistent conduct, responsible communication, and consideration for others. Focusing on

Customers:

The ability to understand and meet the needs, preferences, and experiences of internal and external customers.

Learning Actively:

The ability to pursue learning, seek feedback, and integrate new knowledge to improve personal and professional performance.

Solving Problems:

The ability to identify root causes, analyze relevant data, and apply practical or innovative solutions to challenges. Six years of experience in eligibility determinations for long-term care programs; OR Six years of full-time experience in any field plus three years of experience in eligibility determinations for long-term care programs; OR A bachelor's degree plus three years of experience in eligibility determinations for long-term care programs; OR An advanced degree plus two years of experience in eligibility determinations for long-term care programs.

EXPERIENCE SUBSTITUTION

Every 30 semester hours earned from an accredited college or university will be credited as one year of experience towards the six years of full-time work experience in any field. The maximum substitution allowed is 120 semester hours which substitutes for a maximum of four years of experience in any field. The official job specifications for this role, as defined by the State Civil Service, can be found here .

Job Duties:

Serves as a liaison with fiscal intermediaries and Medicaid Eligibility Systems staff to resolve recipient and provider service, eligibility, and payment discrepancies.
Researches and analyzes provider billing practices, system reports, and payment information to identify issues and recommend appropriate corrective actions or sanctions.
Conducts special studies, analyzes data, compiles reports, and completes projects related to Medicaid Long Term Care eligibility, liability rules, and program operations.
Reviews case samples for accuracy, completeness, quality, and compliance to support Medicaid program integrity and identify opportunities for improvement.
Analyzes federal performance data and program outcomes to identify trends, compare performance, and develop recommendations for operational improvements.
Conducts ongoing programmatic reviews to ensure compliance with state and federal regulations and collaborates with Information Technology staff to ensure policies are accurately reflected in system programming.
Participates in Medicaid training, continuous quality improvement initiatives, provider outreach, emergency preparedness activities, and assists with training Long Term Care staff.

Position-Specific Details:

Location:

Medical Vendor Administration / Eligibility Field Operations / St.

Landry Parish Appointment Type:

This is a promotional opportunity open only to current permanent employees in a classified position with

Louisiana Department of Health, Office of Medical Vendor Administration Cost Center:

305-2050405 Position Number(s): 50603355

Compensation:

This position is eligible for the following Special Entrance Rates (SER), as well as a Premium Pay of up to $2.00/hr for hours worked based on longevity. Medicaid LTC Specialist - $24.35 hourly / $1,948.00 bi-weekly

How To Apply:

No Civil Service test score is required in order to be considered for this vacancy. To apply for this vacancy, click on the \"Apply\" link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.

Information to support your eligibility for the position must be included in the application (i.

e., relevant, detailed experience/education). Resumes will not be accepted in lieu of completed education and experience sections. Applications may be rejected if incomplete.

Contact Information:

Paula.

Jackson@la.gov LA Department of Health (LDH) Division of Human Resources PO Box 4818 Baton Rouge, LA 70821 225- 342-6477 This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218. LDH supports Louisiana's commitment to being a State as a Model Employer (SAME) by promoting the recruitment, hiring, and retention of individuals with disabilities. Information on the Louisiana Works, Louisiana Rehabilitation Services is available here . LDH is an equal opportunity employer and seeks to recruit a highly productive and diverse workforce and will provide equal employment opportunities to all employees and prospective employees. 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