Program Integrity Director Jobs in Baton Rouge, LA

Thank you for your interest in LSU New Orleans.

Once you start the application process, you will not be able to save your work, so you should collect all required information before you begin. The required information is listed below in the job posting.
You must complete all required portions of the application and attach the required documents in order to be considered for employment.

Department

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

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

• 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;

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

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 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.