Medicaid Program Monitor (Medicaid Fee Schedule and Coding Monitor)
: Job Details :

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 withdisabilities.This position is located within the Louisiana Department of Health / Medical Vendor Administration / Program Operations and Compliance / East Baton Rouge ParishAnnouncement Number: MVA/SP/201895Cost Center: 305#######Position Number: 50460657This vacancy is being announced as a Classified position and will be filled as a Probationary appointment.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.*A resume upload will NOT populate your information into your application. Work experience left off your electronic application or only included in an attached resume is not eligible to receive creditFor further information about this vacancy contact:Shambrielle ...@la.govLDH/HUMAN RESOURCESBATON ROUGE, LA 70821This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-###-####.MINIMUM QUALIFICATIONS:A baccalaureate degree plus three years of professional level 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; 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 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 perform advanced research, analyses, and/or policy management activities for Medicaid programs.Level of Work:Advanced.Supervision Received:Broad 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 presence of advanced research, analysis and policy management responsibility.Differs from Medicaid Program Supervisor by the absence of supervisory responsibility.Conducts audits of eligibility enrollment applications; prepares reports on results of each audit.Prepares, interprets and clarifies eligibility policies and procedures.Revises rules, regulations, and procedures to meet changes in law or policy.Compiles data and proposes budgets for subprogram studies and proposed legislation; determines programmatic impact and composes response forfiscal statements and fiscal notes.Reviews current and proposed state and federal regulations and/or revisions to those regulations for hospitals and home health providers.Evaluates new and/or revised regulations to determine the impact to the state Medicaid program.Reviews audits performed by the contracted auditor to determine compliance with federal and/or state policies and regulations, which affect allowable costs.Coordinates compliance monitoring of Medicaid Application Centers statewide.Receives, approves and schedules all requests for Application Center Representative training.Advises and assists field staff in performing on-site monitoring reviews to ensure that the Application Centers adhere to federal, state and agencyrules and regulations.Assist in negotiating contractual agreements between the Department of Health and Hospitals and the Application Centers.Provides functional supervision over contract staff.Monitors and evaluates training provided by contract staff.Prepares the annual budget request utilizing the prescribed format and addendums issued by the Office of Planning and Budget. Prepares detailed analysesand narratives supporting and/or justifying the request as submitted. Responds to requests for additional information and modifications to the budget duringthe legislative approval process.Trains staff of all Medical Vendor Administration sections in fiscal management, budget development and variance reporting.Develops training module and provides essential guidance to managers regarding preparing accurate, pertinent and substantiated data.