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The University of New Orleans

OAAS LT-PCS Appeals - Coordinator 1

The University of New Orleans, Baton Rouge, LA, United States

Thank you for your interest in The University of New Orleans.

Once you start the application process, you will not be able to save your work, so you should collect all required information before you begin. The required information is listed below in the job posting.

You must complete all required portions of the application and attach the required documents in order to be considered for employment.

Department
Program Integrity

Job Summary

Job Description

  • Receive appeal notices and updates, create files for new appeals received, and maintain files appropriately.
  • Review new appeals for the adverse action, reason for appeal, and timeliness of submission.
  • Request Decision/Denial letters on new appeals received.
  • Research data materials to accumulate evidence, prepare summary of evidence (SOE) packets, upload final SOE packets to the Division of Administrative Law SharePoint site, and download rendered decision from appeal hearings via SharePoint.
  • Coordinate with responsible parties, such as other LDH appeal staff, the Division of Administrative Law (DAL) personnel, and the designated contracted agencies.
  • Enter all of the initial data into the Appeals Log once the file has been reviewed, and update the appeals log as needed for each case throughout the entire appeals process.
  • Schedule appeal hearings and represent LDH by presentation of evidence during appeal hearings.
  • Extend and follow up on Prior Authorization for appeals with existing services.
  • Update the electronic file with decisions.
  • Monitor and analyze reports and evaluate monitored findings relative to level of care eligibility and other programmatic policy in OAAS programs.
  • Meet with various LDH staff and contracted consultants as needs arise, and respond to routine, verbal, and written inquiries from agencies, legislators, government officials, general public, and participants as directed by supervisor.
  • Plan and/or conduct/assist with staff meetings, conferences, and assist with training for staff, self-advocates, and providers.
  • Provide systems data to supervisor as needed for analytical reports, and participate in implementation of special programs, projects, and the collection of data for special projects and reports.
  • Other tasks as assigned.
QUALIFICATIONS
REQUIRED:
  • Bachelor's Degree or 6 years' professional work experience in lieu of degree.
  • Excellent analytical skills, effective organizational and time management skills.
  • Excellent verbal and written communications skills.
  • Proficient in the use of Microsoft Office, including but not limited to Outlook, Word, and Excel.
DESIRED:
  • Advanced degree.
  • Minimum 1 year of professional experience in health care field, appeals, or LTC program support.
  • Minimum 1 year of professional experience working with Louisiana's Office of Aging and Adult Services (OAAS) Long Term- Personal Care Services (LT-PCS) policies and procedures.
  • Minimum 1 year of experience working with Telesys Database, Level of Care (LOC) Determinations, Minimum Data Set for Home Care (MDS-HC) and/or Plan of Care (POC) quality review tool.
  • 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;
  • Diversity Statement (required for all Faculty positions and any Staff position of Assistant Manager and higher).


See Diversity Statement instructions by clicking this link: https://www.uno.edu/careers/diversity-instructions

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.