RN - Medicaid Program Integrity Investigator

University of New Orleans; Baton Rouge (LA); Hybride; USD 75 000 - 85 000; Plein temps

Résumé du poste

University of New Orleans invites experienced nurses to join our audit team, focusing on medical and non-medical billing reviews for Medicaid programs. You will develop cases from complaints, analyze evidence, and collaborate with CMS, FBI, and OIG as needed.

On-site audits, interviews, and documentation are core duties, with emphasis on accuracy and regulatory compliance. The role requires an active Louisiana RN license, strong analytical and communication skills, and proficiency with Microsoft

Qualifications

• Valid Louisiana Registered Nurse license to practice professional nursing.
• Three years of professional nursing experience or experience with claims and/or medical record auditing with a public and/or private insurance entity.
• Excellent analytical skills, effective organizational and time management skills.
• Excellent communication skills both oral and written.
• Proficient in the use of Microsoft Office products.

Responsabilités

• Develop cases based on complaints and data profiles related to medical and non-medical care programs.
• Research reports and evidence to determine aberrant billing.
• Collaborate with medical consultants on questionable billing practices and medical necessity.
• Review Medicaid policies and CPT/ICD coding to inform investigations.
• Analyze claims using profiling systems and prepare supporting documents.
• Conduct on-site inspections and interview providers to gather information.
• Prepare documentation for cases and communicate with stakeholders.
• Coordinate informal hearings and testify in appeals as needed.

Connaissances

Nursing license

Analytical skills

Communication skills

Microsoft Office

Formation

Advanced Degree

Outils

Microsoft Word

Excel

Access

Description du poste

University of New Orleans invites experienced nurses to join our audit team, focusing on medical and non-medical billing reviews for Medicaid programs. You will develop cases from complaints, analyze evidence, and collaborate with CMS, FBI, and OIG as needed.

On-site audits, interviews, and documentation are core duties, with emphasis on accuracy and regulatory compliance. The role requires an active Louisiana RN license, strong analytical and communication skills, and proficiency with Microsoft