CAU Long Term Care Eligibility Specialist

Minimum Qualifications

Please click HERE to apply.

• Timely complete appeal actions to re-open and/or close cases in accordance with appeal status. Take precautions to not re-notice appellants when taking these actions.

• Process CAU reversals which will include clearing issues and discrepancies in LaMEDS to assist with the processing of applications and renewals.

• Review data systems to determine what action needs to be performed. Maintain controls to ensure reversals are completed within required deadlines.

• Document eligibility research electronically in the required Medicaid system applications.

• Prepare eligibility decision notices by inputting required data into the corresponding Medicaid application systems, as necessary.

• Maintain knowledge of Medicaid policies and procedures and ensure that any new changes, updates or clearances are applied accordingly.

• Maintain knowledge and usage of all verification systems the agency has access to.

• Interpret and apply complex federal, state, and agency policy. Employ rudimentary knowledge and terminology of legal, medical and business areas, including real estate and insurance.

• Trend and analyze appeals data both regionally and statewide. Develop and produce reporting based on appeals data to influence training needs and decision making.

• Attend and participate in required meetings and trainings.

• Attend LTC hearings when needed.

• Complete LTC appeal packets needed.

• Other tasks as directed.

QUALIFICATIONS

REQUIRED:

• Bachelor's degree or 6 years of professional experience in lieu of degree.

• Minimum two years of professional experience determining Medicaid eligibility.

• Minimum one year of professional experience determining Long Term Care and Waiver eligibility.

• Minimum one year of professional experience utilizing the LaMEDS system.

• Excellent analytical skills, effective organizational and time management skills.

• Great attention to detail and follow up.

• Excellent verbal and written communication skills.

DESIRED:

• Advanced degree.

• Minimum three years of professional experience in determining Medicaid eligibility.

• Minimum two years of professional experience in determining Long Term Care and Waiver Medicaid eligibility

• Minimum two years of professional experience working with Medicaid appeals process.

• Minimum two years of professional experience utilizing the LaMEDS system.