Program Integrity - Coordinator 1

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

Job Summary / 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.

QUALIFICATIONS

• REQUIRED: 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: 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.

SALARY

37‑47k

Required Attachments

• Detailed resume listing relevant qualifications and experience
• Cover Letter indicating why you are a good fit for the position and University of Louisiana Systems
• Names and contact information of three references
• Applications that do not include the required uploaded documents may not be considered.

Posting Close Date

This position will remain open until filled.

Applicants should fully describe their qualifications and experience with specific reference to each of the minimum and preferred qualifications in their cover letter. The search committee will use this information during the initial review of application materials. References will be contacted at the appropriate phase of the recruitment process. This position may require a criminal background check to be conducted on the candidate(s) selected for hire. As part of the hiring process, applicants for positions at the University of New Orleans may be required to demonstrate the ability to perform job-related tasks.

The University of New Orleans is an affirmative action and equal employment opportunity employer. We do not discriminate on the basis of race, gender, color, religion, national origin, disability, sexual orientation, gender identity, protected Veteran status, age if 40 or older, or any other characteristic protected by federal, state, or local law.