Medicaid Program Integrity Investigator I

University of New Orleans; United States; On-site; USD 52,000 - 75,000; Full time

Job summary

LSU New Orleans is seeking a Department Program Integrity Operations professional to investigate Medicaid providers and ensure compliance with federal and state regulations. You will process and track complaints, interact with recipients, providers, LDH, licensing boards, and the Attorney General’s office.

You will document findings, recommend corrective actions, maintain fraud referrals, and contribute to unit reporting.

Qualifications

• Bachelor’s or Associate degree with required experience.
• Strong analytical, organizational and time management skills.
• Strong verbal and written communication skills.
• Proficient in Microsoft Office (Outlook, Word, Excel).

Responsibilities

• Investigate Medicaid providers to ensure expenditures comply with federal and state regulations.
• Process and track Medicaid provider and recipient complaints via email or website.
• Interact with Medicaid recipients, providers, LDH, licensing boards, AG's office, and others.
• Document findings and corrective actions after case reviews.
• Prepare written summaries with relevant background facts.
• Maintain records of fraud, waste and abuse referrals.
• Maintain findings in centralized tracking system and report statistics.
• Refer applicable cases to the Office of the Attorney General.
• May testify as a witness if a case goes to trial.
• Complete special projects as directed by management.

Skills

Analytical skills

Organizational skills

Verbal and written communication

Microsoft Office (Outlook, Word, Excel

Education

Degree or commensurate exp

Tools

Microsoft Office

Job description

LSU New Orleans is seeking a Department Program Integrity Operations professional to investigate Medicaid providers and ensure compliance with federal and state regulations. You will process and track complaints, interact with recipients, providers, LDH, licensing boards, and the Attorney General’s office.

You will document findings, recommend corrective actions, maintain fraud referrals, and contribute to unit reporting.