• Program Integrity (MCU) - Coordinator 2

    Louisiana Department of State Civil Service (Baton Rouge, LA)


    Program Integrity (MCU) - Coordinator 2

     

    Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/5129769)

     

    

     

    Program Integrity (MCU) - Coordinator 2

     

    Salary

     

    Depends on Qualifications

     

    Location

     

    Baton Rouge, LA

     

    Job Type

     

    Unclassified

     

    Job Number

    R-001867

    Department

     

    University of New Orleans

     

    Opening Date

     

    10/31/2025

     

    + Description

    + Benefits

     

    Job Duties and Other Information

     

    •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.

    Required Qualifications:

    •Bachelor’s 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 Qualifications:

    •Advanced degree.

    •Minimum 2 years 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, ICD 10 coding and HCPCS knowledge.

    •CHDA, HIM, RHIA, RHIT, CCA, CMA, CPA, CIA, CGAP, HFMA or other relevant industry certifications.

     

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

     

    Employer

     

    State of Louisiana

     

    Address

     

    For agency contact information, please refer to

     

    the supplemental information above.

     

    Louisiana State Civil Service, Louisiana, 70802

     

    Phone

     

    (866) 783-5462

     

    Website

     

    http://agency.governmentjobs.com/louisiana/default.cfm

     

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