Program Integrity - Coordinator 1

State of Louisiana; Baton Rouge (LA); On-site; USD 52,000 - 70,000; Full time

Job summary

State of Louisiana in Baton Rouge seeks a qualified investigator to analyze Medicaid providers and recipients, ensuring expenditures comply with federal and state regulations and documenting findings.

Responsibilities include processing complaints, coordinating with LDH, OAAS, MFCU and others; preparing written summaries; maintaining records; and supporting legal actions. Required qualifications include a degree or equivalent experience and strong analytical and communication skills.

Qualifications

• Bachelor’s Degree, or Associates degree with 3 years professional experience, or 6 years professional experience in lieu of the degree.
• Excellent analytical skills, effective organizational and time management skills.
• Excellent verbal and written communications skills.
• Proficient in Microsoft Office, including but not limited to Outlook, Word, and Excel.

Responsibilities

• Investigate Medicaid program providers to ensure expenditures comply with Federal and State regulations.
• Process and track all Medicaid provider and recipient related complaints reported via email, the Medicaid Fraud website or internally.
• Interacts with various internal and external entities such as Medicaid recipients, Medicaid providers, LDH program operations, licensing boards, the Attorney General’s office, etc.
• Document findings of investigations initiated by referrals from Medicaid programs including but not limited to OAAS, Behavioral Health, Provider Enrollment, MFCU and Plans.
• Detail any corrective action(s) necessary after conducting a comprehensive case review of findings.
• Ensure all providers are furnished with a written notification of any corrective actions and cite the applicable Medicaid/LaCHIP policy reference.
• Assist in maintaining records of provider fraud, waste and abuse referrals for investigation.
• Maintain findings and results on fraud referrals received within the centralized tracking system.
• Conducts research on all policy violations and corrective action.
• Maintains and assists with up-to-date reporting statistics and data for unit reports.
• Notify management of any trends that are a direct cause of or contributing factor to errors that come to light during the review process or while tracking all cases received for review.
• Refer applicable cases to the Office of the Attorney General.
• Prepare written summary report with all relevant background facts.
• Provide any assistance needed to the legal authority.
• May be called upon as a witness to a case once it proceeds to trial.
• Complete special projects as directed by management.

Skills

Analytical thinking

Organizational and time management

Verbal and written communication

Microsoft Office proficiency (Outlook,

Education

Bachelor’s Degree

Associates degree with 3 years professional experience, or 6 years professional experience in lieu of the degree

Tools

Microsoft Office Suite (Outlook, Word, Excel)

Job description

Job Duties And Other Information

• Investigate providers of various Medicaid programs to ensure expenditures are made in accordance with Federal and State regulations.
• Process and track all Medicaid provider and recipient related complaints reported via email, the Medicaid Fraud website or internally.
• Interacts with varies internal and external entities such as Medicaid recipients, Medicaid providers, LDH program operations, licensing boards, the Attorney General’s office, etc.
• Document findings of investigations initiated by referrals from Medicaid programs including but not limited to OAAS, Behavioral Health, Provider Enrollment, MFCU and Plans.
• Detail any corrective action(s) necessary after conducting a comprehensive case review of findings.
• Ensure all providers are furnished with a written notification of any corrective actions and cite the applicable Medicaid/LaCHIP policy reference.
• Assist in maintaining records of provider fraud, waste and abuse referrals for investigation.
• Maintain findings and results on fraud referrals received within the centralized tracking system.
• Conducts research on all policy violations and corrective action.
• Maintains and assists with up-to-date reporting statistics and data for unit reports.
• Notify management of any trends that are a direct cause of or contributing factor to errors that come to light during the review process or while tracking all cases received for review.
• Refer applicable cases to the Office of the Attorney General.
• Prepare written summary report with all relevant background facts.
• Provide any assistance needed to the legal authority.
• May be called upon as a witness to a case once it proceeds to trial.
• Complete special projects as directed by management.

Required Qualifications

• Bachelor’s Degree, or Associates degree with 3 years professional experience, or 6 years professional experience in lieu of the degree.
• Excellent analytical skills, effective organizational and time management skills.
• Excellent verbal and written communications skills.
• Proficient in the use of Microsoft Office, including but not limited to Outlook, Word, and Excel.

Desired Qualifications

• Advanced degree.
• 2 years professional experience in provider enrollment and credentialing.
• 1 year professional experience with Louisiana Medicaid policy and procedures.
• Experience with Electronic Visit Verification.
• Experience with data analysis and report development.

Benefits for unclassified employees are determined by the individual hiring authority.