Program Integrity - Coordinator 1

University-of-New-Orlean; Baton Rouge (LA); On-site; USD 52,000 - 78,000; Full time

Job summary

University of New Orleans is seeking a detail-oriented investigator to support Medicaid program compliance, internal/external communication, and case management. The role involves reviewing referrals, documenting findings, and coordinating corrective actions under regulatory guidelines.

The candidate should have strong analytical abilities, proven organizational skills, and proficiency in Microsoft Office. A degree or equivalent experience is required, with preference for advanced credentials.

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 Outlook, Word, and Excel.

Responsibilities

• 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.
• Interact with 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 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 skills

Organizational skills

Verbal and written communications

Microsoft Office

Education

Bachelor’s Degree

Associates degree + 3 years experience

6 years experience in lieu of degree

Tools

Microsoft Office Suite

Job description

• 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.