MEDICAID PROGRAM SPECIALIST 1-2

Requirements

MINIMUM QUALIFICATIONS:
Three years of experience in research and analysis related to Medicaid programs; public health, public relations, social services, health services, or administrative services; OR

Six years of full-time work experience in any field; OR

A bachelor's degree.

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.

Qualifications

Function of Work:
To perform research and analysis related to Medicaid programs.

Level of Work:
Entry.

Supervision Received:
Close from a Medicaid Program Supervisor or above.

Supervision Exercised:
None.

Location of Work:
Department of Health and Hospitals, Medical Vendor Administration.

Job Distinctions:
Differs from Medicaid Program Specialist 2 by the close supervision received and the absence of independent action.Maintains an extensive working knowledge of all Medicaid programs, policy and procedures, and eligibility and ancillary systems in order to effectively communicate Medicaid policy and eligible with members, potential members, and providers. Responsible for working accurately and independently within the Louisiana Medicaid Eligibility Determination System (LaMEDS) to perform, at minimum, the following actions: research person or case level records, complete Medicaid applications and renewals, provide information on case status and Medicaid program coverage, complete requests for duplicate cards, complete requests for case changes such as changes to demographic information. Complete a change report to report a change in income, add or remove case members. The Medicaid Program Specialist should be able to read and interpret case notes and notices. Responsible for employing knowledge of Medicaid eligibility policy and procedure to interpret and communicate eligibility determinations, including decision letters. Responsible for recognizing trends in communications and potential errors notices / determinations and escalating same thru the chain of command. Responsible for professional and considerate attention in all interactions. Responsible for communicating effectively with members, potential members, and providers in the manner (phone, email) of their choosing. The Medicaid Program Specialist should utilize soft skills in all interactions including empathy, problem solving, patience, active listening, conflict resolution, emotional intelligence, creativity, time management, critical thinking, and social skills. Responsible for understanding and applying cultural competency. Responsible for delivering information in an easy-to-understand manner based on the receiving audience. Responsible for meeting or exceeding customer service agent metrics set forth by the call center leadership. This includes first call resolution, average speed to answer, and customer satisfaction. Responsible for contribution to and support of customer service center metrics including but not limited to abandonment rates, average speed to answer, time in queue, and service levels. Participates and engages in all Medicaid policy, procedure, and systems training. Participates in all MSD, regional and statewide trainings as directed. Participates in continuous quality improvement initiatives including Micro learnings, Agile and Lean Six Sigma. Performs other duties as assigned in support of the mission of Eligibility Field Operations as directed by unit or section leadership. Assists others to meet needs and priorities of the Section and Department as required.