Program Integrity - Coordinator 1

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

Department Program Integrity Operations Job Summary

• 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.

Required Attachments

• Detailed resume listing relevant qualifications and experience
• Cover Letter indicating why you are a good fit for the position and LSU New Orleans
• Names and contact information of three references

This position will remain open until filled.

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 LSU New Orleans may be required to demonstrate the ability to perform job-related tasks.

LSU New Orleans seeks to recruit a highly productive workforce and will provide equal employment opportunities to all employees and prospective employees. Employment decisions shall be based strictly on merit and without regard to religious or political beliefs, sex, race, or any other non‑merit factor.

About LSU New Orleans

LSU New Orleans is the only R2 public research university in New Orleans, Louisiana, and one of just four public colleges in Louisiana to hold that designation. R2 status opens the doors to competitive federal research grants that flow preferentially to classified research universities. It anchors the university’s power to recruit research‑active faculty, to sustain doctor programs of national standing, and to signal to businesses and investors that New Orleans possesses the intellectual infrastructure a knowledge economy demands. Located along Lake Pontchartrain in New Orleans, LSU New Orleans’ research excellence and urban relevance provide an opportunity for the institution to become a leading public research partner in one of America’s most exciting and vibrant metropolitan areas. New Orleans has always faced challenges that call for research driven solutions including coastal land loss, educational achievement gaps, affordability, public safety, and workforce shortages. LSU New Orleans can strengthen its research activity as a tool for public problem solving as well as economic impact by leveraging the scale, reputation, infrastructure, and global reach of the LSU enterprise while remaining deeply connected to the city it serves. With more than 5,500 students and the support of approximately 248 faculty serving the College of Liberal Arts & Human Development, The college of Sciences, The Robert A. Savoie College of Engineering, the Henry Berstein College of Business Administration, and six distinct schools, the campus remains committed to honoring its founding vision and continuing to play a critical role in the region. Opened in 1958 on the site of a former U.S. Naval Air Station as the region’s first fully integrated public university, LSU New Orleans was created after years of coordinated efforts from civic leaders and residents who believed that an accessible public institution of higher education was vital to the city’s future. Located only 15 minutes away from downtown and the French Quarter, the university occupies a 195‑acre campus in one of the nicest residential areas of the city. Since its first commencement exercises in 1962, the university has conferred more than 80,000 degrees creating an extensive network of Privateer Alumni that includes prominent local leaders in fields such as business, tourism, athletics, government, and academia. The university is also an important catalyst of socio‑economic mobility for the region. Its student body includes a significant share of first‑generation students, working students, adult learners, and veterans. The institution has grown from a commuter‑oriented campus into a comprehensive urban research university with undergraduate, graduate, and doctoral programs in distinctive academic categories tied to the city and region. Its evolution has been inseparable from the story of New Orleans; an internationally recognized city of creativity, resilience, industry, cultural influence, and global connectivity. As one of the most strategically important cities in America, New Orleans’s economy is rooted in legacy sectors such as energy, maritime commerce, tourism, healthcare, and international trade. Recently, the city has expanded its economic portfolio to include areas such as coastal restoration, film and media production, technology, and advanced manufacturing. The city’s strengths are the university’s opportunities. New Orleans needs talent, civic leadership, resilient infrastructure, healthcare innovation, artists, and entrepreneurs. This combination of culture, commerce and connectivity gives LSU New Orleans a set of dynamic factors that allows it to serve as both an access institution and a problem‑solving university as it reinvents itself beginning this summer.

LSU New Orleans Welcomes Job Applicants from Varied Backgrounds LSU New Orleans seeks to recruit a highly productive workforce and will provide equal employment opportunities to all employees and prospective employees. Employment decisions shall be based strictly on merit and without regard to religious or political beliefs, sex, race, or any other non‑merit factor.