Program Integrity (MCU) - Coordinator 2

Job Summary

Assess Managed Care Entity (MCE) compliance with contract deliverables.

Review and assess fraud, waste, and abuse (FWA) investigation reports, referrals, and tips from MCEs.

Identify and investigate audit leads and risk areas within the Medicaid program.

Plan and perform all phases of desk and on-site reviews of provider or MCE facilities. Includes selecting an audit sample, inspecting / assessing facilities, obtaining records necessary to conduct a thorough and complete investigation, and conducting interviews with the health plan or provider and staff.

Prepare case documents, audit summaries, and reports.

Coordinate law enforcement requests, managed care investigations, external audit requests, referrals, tips, and complaints with MCEs, MFCU, and other Program Integrity staff.

Maintain case lists, investigation documents, Program Integrity policies and procedures, written communications and directives sent to MCEs, and other programmatic documentation as requested.

Recommend appropriate sanctions or corrective actions based on audit or investigation findings.

Research and assist with MCE contract questions; recommend contract and policy changes as needed.

Educate providers on appropriate billing and Medicaid policy, rules, and regulations.

Assist with data mining and other special projects at the request of LDH Program Integrity staff.

Assist with development of reports and data dashboards to enhance MCE oversight efforts.

Assist co-workers with questions and / or issues that arise.

Assist with MFCU / PI / MCE meetings and communications.

Other duties as assigned.

Qualifications

Required :

• Bachelor's Degree, or Associates degree with 3 years professional experience, or 6 years professional experience in lieu of degree.
• Minimum 1 year of professional experience in auditing, policy, data analysis, or claims monitoring / processing.
• Excellent analytical skills, effective organizational and time management skills.
• Great attention to detail and follow up.
• Ability to manage projects, assignments, and competing priorities.
• Proficient in the use of Microsoft Office, including but not limited to Outlook, Word, and Excel.

Desired :

Required Attachments :

Please upload the following documents in the Resume / Cover Letter section.

Applications that do not include the required uploaded documents may not be considered.

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.

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.