Medicaid Program Manager 1--A

The Louisiana Department of Health is dedicated to fulfilling its mission through direct provision of quality services, the development and stimulation of services of others, and the utilization of available resources in the most effective manner.

LDH serves as a model employer for individuals with disabilities.

This position is located within the Louisiana Department of Health / Medical Vendor Administration / Program Operations and Compliance / East Baton Rouge Parish

Announcement Number: MVA/SP/200461

Cost Center: 3052020600

Position Number: 69001

This vacancy is being announced as a Classified position and will be filled as a Job appointment.

(Job appointments are temporary appointments that may last up to 48 months)

Preferred Qualifications

Preference will be given to candidates with a background in medical billing, coding, claims research, and/or payment resolution as well as candidates with a medical billing certification from the America Medical Billing Association, (AMBA).

Occupational Summary

This is a highly responsible management position in the Program Operations & Compliance section located within the Bureau of Health Services Financing (BHSF) that reports directly to the Medicaid Program Manager 1 B.  This section is responsible for oversight of policy and procedures for Medicaid benefits, processing appeals and serving as the state representative in appeal hearings, resolution of benefit & service issues, basic program compliance, fee schedule updates, assisting with policy interpretation, and the overall covered services and benefits available to Medicaid enrollees.

This position will be directly responsible for implementing covered benefits, services and programs and treatments within the Medicaid State Plan delivered through either Managed Care or Legacy Medicaid. Successful candidates in this position will possess sound verbal and written communication skills.

Job duties include, but are not limited to:

• Responsible for the statewide management of durable medical equipment and vision/eye-wear programs.  This includes the administration of the day-to-day activities for the programs.

• Responsible for planning and developing policy and procedures for these statewide Medicaid programs

• Serves as the manager and primary point of contact between LDH and its contractors including Managed Care Organizations (MCO) and the Fiscal Intermediary (FI) for Medicaid services and policy clarification

• Manages complaints from beneficiaries, providers and legislators by researching and reviewing Medicaid rules, member eligibility and program policy. Directs MCOs and FI regarding actions required to eliminate access to care issues and inappropriate adjudication of claims and prior authorizations.

• Analyzes expenditures and utilization of durable medical equipment for submission to the Center for Medicare and Medicaid Services annual report submission to ensure compliance with federal regulations.

• Oversees prior authorizations processed by the FI to confirm appropriate adjudication based on program policy.  Manages the Prior Authorization Liaison (PAL) referral process for assigned Medicaid programs to ensure compliance.

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.

• Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.*

For further information about this vacancy contact:

Shambrielle Pooler

Shambrielle.Pooler@la.gov

LDH/HUMAN RESOURCES

BATON ROUGE, LA 70821

This organization participates in E-Verify, and for more information on E-Verify, please contact DHS at 1-888-464-4218.  

MINIMUM QUALIFICATIONS:

A baccalaureate degree plus four years of professional experience in administrative services, economics, public health, public relations, statistical analysis, social services, or health services.

SUBSTITUTIONS:

Six years of full-time work experience in any field may be substituted for the required baccalaureate degree.

Candidates without a baccalaureate degree may combine work experience and college credit to substitute for the baccalaureate degree as follows:

A maximum of 120 semester hours may be combined with experience to substitute for the baccalaureate degree.

30 to 59 semester hours credit will substitute for one year of experience towards the baccalaureate degree.

60 to 89 semester hours credit will substitute for two years of experience towards the baccalaureate degree.

90 to 119 semester hours credit will substitute for three years of experience towards the baccalaureate degree.

120 or more semester hours credit will substitute for four years of experience towards the baccalaureate degree.

College credit earned without obtaining a baccalaureate degree may be substituted for a maximum of four years full-time work experience towards the baccalaureate degree. Candidates with 120 or more semester hours of credit, but without a degree, must also have at least two years of full-time work experience tosubstitute for the baccalaureate degree.

Graduate training with eighteen semester hours in one or any combination of the following fields will substitute for a maximum of one year of the required experience on the basis of thirty semester hours for one year of experience: public health; public relations; counseling; social work; psychology; rehabilitation services; economics; statistics; experimental/applied statistics; business, public, or health administration.

A master's degree in the above fields will substitute for one year of the required experience.

A Juris Doctorate will substitute for one year of the required experience.

Graduate training with less than a Ph.D. will substitute for a maximum of one year of the required experience.

A Ph.D. in the above fields will substitute for two years of the required experience.

Advanced degrees will substitute for a maximum of two years of the required experience.

NOTE:

Any college hours or degree must be from an accredited college or university.

Function of Work:

To administer small and less complex statewide Medicaid program(s).

Level of Work:

Program Manager.

Supervision Received:

Broad from a higher-level manager/administrator.

Supervision Exercised:

May provide functional supervision in accordance with the Civil Service Allocation Criteria Memo.

Location of Work:

Department of Health and Hospitals.

Job Distinctions:

Differs from Medicaid Program Monitor by responsibility for administering small and less complex statewide program(s).

Differs from Medicaid Program Manager 1-B by the absence of supervisory responsibility.

Differs from Medicaid Program Manager 2 by the absence of responsibility for administering medium size and moderately complex statewide program(s).Supervises the auditing of eligibility enrollment of all Medicaid programs statewide.

Reviews work of eligibility review staff for quality assurance.

Plans, coordinates, and controls small or less complex statewide program(s).

Plans, develops, implements and monitors comprehensive Medicaid program policies.

Conducts and directs studies/special projects pertaining to the programs assigned.

Analyzes the impact of federal, state, and local legislation; advises agency officials; prepares position statements; presents testimony at hearings; writes legislation.

Reviews and analyzes complex data and system reports to ensure compliance with program regulations.

Administers the day-to-day operational functions of the Medicaid fee for service programs. Assures that program policy and procedures are properly applies in accordance with federal and state laws and regulations.

Develops and writes agency rules and regulations governing the administration of all supervised Medicaid programs and submit them for publishing in the official state publication in accordance with the requirements of the Administrative Procedures Act.

Implements Medicaid regulations directing provider participation standards and recipient benefits. Analyzes multi-mullion dollar Medicaid claim data and project the fiscal impact for budget forecasting.

Identifies, verifies and analyzes the various revenue sources for the program(s). Determines and/or confirms match requirements. Monitors availability of revenue sources and promptly identifies existing or potential financing problems.