Medicaid Program Integrity Investigator I

LSU New Orleans; New Orleans (LA); On-site; USD 37,000 - 47,000; Full time

Job summary

University of New Orleans seeks a candidate to investigate Medicaid providers, ensuring expenditures comply with federal and state regulations. You will process complaints, coordinate with Medicaid stakeholders, and document findings with corrective actions.

The role requires strong analytical, organizational, and communication skills and proficiency with MS Office. Responsibilities include maintaining fraud referral records, preparing background summaries, and assisting legal authorities.

Qualifications

• Bachelor’s Degree or equivalent with 3 years professional experience, or 6 years professional experience in lieu of degree.
• Excellent analytical skills, organizational and time management skills.
• Excellent verbal and written communications skills. Proficient in Microsoft Office (Outlook, Word, Excel).
• Advanced degree desired and experience in provider enrollment/credentialing is a plus.

Responsibilities

• Investigate Medicaid providers to ensure expenditures align with Federal and State regulations.
• Process and track complaints related to Medicaid providers and recipients.
• Interact with Medicaid recipients, providers, LDH, licensing boards, and Attorney General’s office.
• Document findings and recommend corrective actions with policy references.
• Keep centralized tracking records of fraud referrals and prepare summary reports.
• Possibly serve as a witness; assist in special projects as directed by management.

Skills

Analytical skills

Organizational skills

Time management

Verbal communications

Written communications

MS Office

Education

Bachelor's Degree

Associates degree + 3 years experience

6 years professional experience in lieu of degree

Tools

Microsoft Office

Electronic Visit Verification

Job description

University of New Orleans seeks a candidate to investigate Medicaid providers, ensuring expenditures comply with federal and state regulations. You will process complaints, coordinate with Medicaid stakeholders, and document findings with corrective actions.

The role requires strong analytical, organizational, and communication skills and proficiency with MS Office. Responsibilities include maintaining fraud referral records, preparing background summaries, and assisting legal authorities.