Medicaid Program Integrity Clinician – RN

LSU New Orleans; New Orleans (LA); On-site; USD 75,000 - 85,000; Full time

Job summary

LSU New Orleans seeks a licensed Registered Nurse to develop case-based reviews of complex billing for medical and non-medical care programs, auditing claims and records.

You will interview providers, analyze CPT/ICD coding, collaborate with CMS and other agencies, and prepare financial memorandums. The role requires strong analytical and communication skills and proficiency with Microsoft Office.

Qualifications

• Valid Louisiana RN license required.
• Three years of professional nursing or claims/audit experience with public/private insurer desired.
• Excellent analytical and communication skills; strong organizational abilities.

Responsibilities

• Develop a case based on a complaint and related data profiles to identify billing issues.
• Research, analyze reports, and determine aberrant billing in medical and non-medical care programs.
• Collaborate with medical consultants and agency staff on questionable billing practices and records requests.
• Prepare financial memorandums and necessary documentation for reviews and investigations.

Skills

Analytical skills

Communication skills

Interpersonal skills

Education

Louisiana RN license

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

MMIS

Job description

LSU New Orleans seeks a licensed Registered Nurse to develop case-based reviews of complex billing for medical and non-medical care programs, auditing claims and records.

You will interview providers, analyze CPT/ICD coding, collaborate with CMS and other agencies, and prepare financial memorandums. The role requires strong analytical and communication skills and proficiency with Microsoft Office.