Claims Policy and Processing Analyst

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Department

Medicaid Support

Job Summary

Job Description

• Responsible for the creation of an inventory for all highly complex and specialized processing / editing logic, including changes and updates, within the Medicaid Management Information System for claims and encounter processing.
• Responsible for the research and development of a cross reference system for all current and historical policies, health plan advisories, informational bulletins, etc.

related to the processing / editing logic used for claims and encounter processing within the Medicaid Management Information System

• Responsible for the creation, maintenance and distribution of a maintenance schedule for processing / editing logic within the Medicaid Management Information System
• Communicate effectively with fiscal intermediary to gather and document any and all highly complex processing / editing logic, including source code.
• Communicate effectively with internal Medicaid staff to understand policy affecting claims and encounter processing, including any necessary changes or updates made or to be made
• Serve as the subject matter expert on processing / editing logic as well as policy impacting claims and encounter processing.
• Independently review, monitor, analyze, evaluate, and report on claims and encounter processing reports generated by the Fiscal Intermediary.
• Researches relevant information from the enrollees, providers, LDH Staff, FI Staff, policy and procedure manuals, and various MMIS subsystems in order to facilitate proper claims adjudication.
• Finalize work in a timely manner set by the department’s supervisor.
• Leads and assists higher level Managers with special projects and / or other duties as assigned.
• Other tasks as directed.

QUALIFICATIONS

REQUIRED :

• Bachelor’s Degree or 6 years of professional work experience in lieu of degree.
• Minimum 2 years of professional experience with private insurance or Medicaid claims processing
• Medical coding (CPT and ICD-10) experience
• Excellent analytical skills, effective organizational and time management skills.
• Strong analytical, problem-solving / troubleshooting skills.
• Proficient in the use of Microsoft Office, including but not limited to Outlook, Word, and Excel.

DESIRED :

• Advanced degree.
• Minimum 2 years of professional experience with Medicaid relevant to MMIS policy and systems
• Minimum 1 year of experience with auditing, compliance or policy writing.
• Minimum 1 year of experience in the use of Excel formulas, lookups, pivots, formatting and statistical analysis.
• CPT certification.

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 :

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.