Status: Full-time

Department: Medicaid Services Contract – Program Integrity

Posted: Wednesday, March 25, 2020

Salary: Commensurate with qualifications and experience.

Job ID: 9989, 9986, 9966, 9961, 9960

Position Summary

5 positions located in Baton Rouge

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.
• 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 6 years of professional experience in lieu of 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.

Closing Date

Position will remain open until filled.