Program Integrity (Managed Care Unit) – Coordinator 1


DEPARTMENT

Medicaid Technical Services Contract


POSITION SUMMARY

(2 positions located in Baton Rouge) 9382 & 9666


RESPONSIBILITIES

• 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. • Other duties as assigned.


REQUIRED QUALIFICATIONS

• Bachelor’s Degree. • 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 QUALIFICATIONS

• Advanced degree. • Minimum 1 year of professional experience in auditing, policy, data analysis, or claims monitoring/processing. • Professional experience in government programs, healthcare, criminal justice, or accounting. • Experience writing and conducting queries using SQL and/or SAS. • CPT, ICD­10 coding and HCPCS knowledge. • CHDA, HIM, RHIA, RHIT, CCA, CMA, CPA, CIA, CGAP, HFMA or other relevant industry certifications.


SALARY

Commensurate with qualifications and experience.


DATE POSTED

09/18/2017


CLOSING DATE

Position will remain open until filled. To assure full consideration, applications should be received by September 29, 2017.


POSITION NUMBER

9382

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