Program Integrity - Coordinator 1

Other Qualifications

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• 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.

Benefits

Benefits for unclassified employees are determined by the individual hiring authority.

Agency Information

EmployerState of LouisianaAddress 1201 N 3rd St

Baton Rouge, Louisiana, 70802 Phone(866) 783-5462
Website http://agency.governmentjobs.com/louisiana/default.cfm