Medicaid Program Integrity Clinician

University-of-New-Orlean

Baton Rouge (LA)

On-site

USD 65,000 - 90,000

Full time

14 days+

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Job summary

University of New Orleans is seeking a licensed Registered Nurse to develop case files on billing problems related to medical and non-medical care programs. You will apply clinical expertise to review records and identify aberrant billing patterns.

Collaborate with medical consultants, research relevant Medicaid publications, and analyze claims using profiling tools. Strong communication and MS Office skills are essential to prepare findings and document cases.

Qualifications

Possession of a valid Louisiana RN license to practice nursing.
Three years of nursing experience or claims/medical record auditing experience.
Excellent analytical, organizational and time management skills.
Excellent oral and written communication skills.
Proficiency with Microsoft Office products.

Responsibilities

Develop a case based on a complaint and data profile; identify initial billing problems.
Research and analyze reports to determine if aberrant billing occurred.
Collaborate with medical consultants on questionable medical necessity of services.
Review Medicaid provider manuals, coding publications and related rules.
Analyze claims and encounter data using profiling systems and prepare supporting documents.
Interview providers and staff to obtain crucial information for reviews.