Medicaid Program Integrity Nurse Auditor

University of New Orleans; Baton Rouge (LA); On-site; USD 75,000 - 85,000; Full time

Job summary

University of New Orleans seeks a Compliance Operations professional in Baton Rouge to develop case-based reviews of Medicaid billing irregularities, applying clinical judgment to records and collaborating with medical consultants. The role requires an active Louisiana RN license, 3 years nursing or auditing experience, strong analytical and communication skills, and proficiency with Microsoft Office.

Advanced degrees and/or certifications are preferred.

Qualifications

• Possession of a valid Louisiana Registered Nurse license to practice professional nursing.
• Three years of professional nursing experience or experience with claims and/or medical record auditing with a public and/or private insurance entity.
• Excellent analytical skills, effective organizational and time management skills.
• Excellent communication skills both oral and written.
• Proficient in the use of Microsoft Office products.

Responsibilities

• Develop a case based on a complaint and/or data profile while identifying the initial billing problem(s).
• Research and analyze reports and evidence to determine if aberrant billing occurred.
• Collaborate with medical consultants on questionable billing practices and with program staff during reviews.
• Research Medicaid manuals and coding publications to inform reviews.
• Analyze claims data and generate supporting documents for investigations.

Skills

Analytical skills

Organizational skills

Time management

Communication skills

Education

Louisiana RN license

Advanced degree (preferred)

Tools

Microsoft Office

Job description

University of New Orleans seeks a Compliance Operations professional in Baton Rouge to develop case-based reviews of Medicaid billing irregularities, applying clinical judgment to records and collaborating with medical consultants. The role requires an active Louisiana RN license, 3 years nursing or auditing experience, strong analytical and communication skills, and proficiency with Microsoft Office.

Advanced degrees and/or certifications are preferred.