Program Integrity - Coordinator 1

University of New Orleans; United States; On-site; USD 37,000 - 47,000; Full time

Job summary

The University of New Orleans is hiring for a position in Program Integrity Operations to investigate Medicaid program compliance while ensuring adherence to Federal and State regulations. Responsibilities include processing and tracking complaints, conducting investigations, preparing comprehensive reports, and assisting in maintaining accurate data.

The ideal candidate should have a Bachelor’s Degree or equivalent experience, possess excellent analytical, organizational, and communication skills, and be proficient in Microsoft Office. A commitment to supporting compliance within Medicaid programs is essential.

Qualifications

• Bachelor’s Degree, or Associate’s 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 communication skills.
• Proficiency in Microsoft Office, including Outlook, Word, and Excel.

Responsibilities

• Investigate Medicaid program providers to ensure compliance with regulations.
• Document findings and corrective actions related to Medicaid complaints.
• Maintain records of fraud, waste, and abuse referrals for investigation.
• Prepare reports for management and legal authorities as needed.

Skills

Analytical skills

Organizational skills

Time-management skills

Verbal communication

Written communication

Proficiency in Microsoft Office

Education

Bachelor’s Degree or Associate’s degree with 3 years experience

Job description

Job Summary

Department Program Integrity Operations

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 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.

Provide a comprehensive case review of findings, detail any corrective action(s) necessary, and ensure all providers are furnished with a written notification of corrective actions citing 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, and conduct research on all policy violations and corrective actions.

Maintain and assist with up‑to‑date reporting statistics and data for unit reports. Notify management of any trends that are a direct cause or contributing factor to errors discovered 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 reports with all relevant background facts, and provide assistance to the legal authority when needed. 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 Associate’s 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 communication skills.
• Proficiency in Microsoft Office, including 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.

Posting Close Date

This position will remain open until filled.

Note to Applicant

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.

Equal Employment Opportunity

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.