Medicaid Program Manager 2 (Claims and Encounters Manager) Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/5007918) Apply  Medicaid Program Manager 2 (Claims and Encounters Manager) Salary $5,751.00 - $11,284.00 Monthly Location Baton Rouge, LA Job Type Classified Job Number MVA/SP/210657 Department LDH-Medical Vendor Administration Opening Date 07/16/2025 Closing Date 7/23/2025 11:59 PM Central + Description + Benefits About this Job The mission of the Louisiana Department of Health is to protect and promote health and to ensure access to medical, preventive, and rehabilitative services for all residents of the State of Louisiana. Learn more about Louisiana Department of Health (https://ldh.la.gov/) This position is responsible for administering and monitoring complex Medicaid programs to support the Medicaid Enterprise Systems (MES) section with oversight from the Medicaid Program Manager 3. This position will be responsible for administering the overall systematic and operational decisions related to encounter processing for managed care programs and the FFS program. This is a highly responsible and trusted position that ensures all state and federal guidelines are met for encounter processing. This position is responsible for 3 direct and 14 indirect subordinates. This position is also responsible for managing the encounter and claims processing components of modularity including the vendor and its systems. Minimum Qualifications Seven years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR Six years of full-time work experience in any field plus four years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR A bachelor’s degree plus four years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR An advanced degree or a Juris Doctorate plus three years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services. 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. Job Specification The official job specifications for this role, as defined by the State Civil Service, can be foundhere. Job Duties and Other Information Job Duties: + Responsible for administering the day-to-day operational functions for the Medicaid managed care encounter programs and FFS programs. Responsible for directing, reviewing, and approving work of encounter processing staff including encounter data submission, denial and void rates, processing of encounter history requests, processing timely filing override requests, encounter investigations, updates to encounter postings, and receiving and resolving requests from MCEs and providers. + Responsible for identifying, verifying and analyzing various revenue and payment sources for the program. + Responsible for analyzing the impact of federal and state legislation for Medicaid management and LDH Leadership to use in legislative briefing documents. Advise leadership of trends that may adversely affect MES. Project fiscal impact of correspondence for budget forecasting. + Plans and directs the work of staff to ensure they are performing efficiently and effectively to meet the needs of over 1.7million members and 80,000 providers. + Responsible for performing other duties as assigned to assist with the management and operations of the assigned section including assisting with other duties not listed herein. Position-Specific Details: Location:Medical Vendor Administration / Medicaid Enterprise Systems / East Baton Rouge Parish Appointment Type: Probationary appointment, Promotional appointment, or Detail to Special Duty Cost Center: 3052080300 Position Number(s): 50396487 LDH supports Louisiana’s commitment to being a State as a Model Employer (SAME) by promoting the recruitment, hiring, and retention of individuals with disabilities. How To Apply: 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. *Information to support your eligibility for the position must be included in the application (i.e., relevant, detailed experience/education). Resumeswill notbe accepted in lieu of completed education and experience sections. Applications may be rejected if incomplete. Contact Information: Shambrielle Pooler Shambrielle.Pooler@la.gov LA Department of Health (LDH) Division of Human Resources PO Box 4818 Baton Rouge, LA 70821 225-342-6477 This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218. Louisiana State Government represents a wide variety of career options and offers an outstanding opportunity tomake a differencethrough public service. With an array of career opportunities in every major metropolitan center and in many rural areas, state employment provides an outstanding option to begin or continue your career. As a state employee, you will earn competitive pay, choose from a variety of benefits, and have access to a great professional development program: Insurance Coverage More information can be found at https://info.groupbenefits.org/ Parental Leave– Up to six weeks paid parental leave More information can be found athttps://www.civilservice.louisiana.gov/Parental-Leave/Default.aspx Holidays and Leave – State employees receive the following paid holidays each year: + New Year's Day + Martin Luther King, Jr. Day, + Mardi Gras, + Good Friday, + Memorial Day, + Independence Day, + Labor Day, + Veteran's Day, + Thanksgiving Day and Christmas Day. ***** Additional holidays may be proclaimed by the Governor State employees earn sick and annual leave which can be accumulated and saved for future use. Your accrual rate increases as your years of service increase. Retirement – State of Louisiana employees are eligible to participate in various retirement systems (based on the type of appointment and agency for which an employee works). These retirement systems provide retirement allowances and other benefits for state officers and employees and their beneficiaries. State retirement systems may include (but are not limited to): + Louisiana State Employees Retirement System (www.lasersonline.org). LASERS has provided this video (https://lasersonline.org/wp-content/uploads/2016/07/Your\_Retirement\_System.mp4) to give you more detailed information about their system + Teacher's Retirement System of Louisiana (www.trsl.org), + Louisiana School Employees Retirement System (www.lsers.net), among others Employer State of Louisiana Address For agency contact information, please refer to the supplemental information above. Louisiana State Civil Service, Louisiana, 70802 Phone (866) 783-5462 Website http://agency.governmentjobs.com/louisiana/default.cfm Apply Please verify your email addressVerify Email