Program Integrity - Coordinator 1

University of New Orleans•Baton Rouge, LA

2d•Onsite

About The Position

This position involves investigating providers of various Medicaid programs to ensure expenditures are made in accordance with Federal and State regulations. The role includes processing and tracking complaints, interacting with various internal and external entities, documenting investigation findings, detailing corrective actions, and ensuring providers are notified of these actions. The coordinator will also assist in maintaining records of fraud, waste, and abuse referrals, maintaining findings in a centralized tracking system, conducting research on policy violations, and assisting with reporting statistics. Additionally, the role requires notifying management of trends contributing to errors, referring applicable cases to the Office of the Attorney General, preparing written summary reports, providing assistance to legal authorities, and potentially serving as a witness in trials. Special projects as directed by management will also be part of the responsibilities.

Requirements

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.

Nice To Haves

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.

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 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.
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.
Conduct research on all policy violations and corrective action.
Maintain and assist 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.