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 Compliance Operations Job Summary Job Description Develop a case based on a complaint and/or data profile while identifying the initial billing problem(s) related to medical and non-medical care programs. Research and analyze all reports and other evidence obtained to determine if aberrant billing has occurred. Apply medical expertise to determine the requests of pertinent records based on review of the sample. Collaborate with a variety of medical consultants relative to questionable billing practices related to medical necessity of services. Work with applicable program management staff, contract staff and other staff from agencies involved in case reviews and investigations. Research and discern pertinent information from Medicaid provider manuals, medical coding and diagnosis publications, Medicaid publications/rules/regulations and other medical resources. Analyze claims and encounter data using a robust computer profiling system to isolate and identify aberrancies and outliers. Produce spreadsheets and other documents to support analyses and findings from the investigations and reviews. Conduct on-site inspections and assessments of provider facilities and procure medical records, equipment lists, employee records, etc. deemed necessary to conduct a thorough and complete review. Possess the interpersonal and professional skills necessary to interview providers and their employees. Verify all medical equipment including laboratory used to bill Medicaid. Interview physicians, office and support staff or other provider types to obtain crucial information needed to complete the reviews. Document and summarize information from interviews and observations from on-sites. Utilize expertise and knowledge to interpret documentation, procedure codes and diagnoses included in provider and recipient histories and associated reports. Interpret claims and encounter histories by utilizing professional clinical publications such as the Current Procedural Terminology (CPT) manuals and companion guides, Healthcare Common Procedure Coding System (HPCS) and International Classification of Diseases (ICD) books. Prepare and maintain documentation for cases. Communicate verbally as well as through written correspondence to providers, recipients, attorneys, etc. Complete and document items timely throughout the review/investigation process. Receive, monitor and track monies recovered as a result of the reviews/investigations. Prepare financial memorandums and promissory notes for payments relating to caseloads. Develop cases while conferring with staff from the Centers for Medicare and Medicaid (CMS), Federal Bureau of Investigations (FBI), Medicaid Fraud Control Unit (MFCU), Office of Inspector General (OIG), United States Attorney and other governmental agencies participating in the review/investigations. Formulate and research information by utilizing the Medicaid Management Information System (MMIS), Microsoft Word, Excel, Access and other applicable software. Supply information needed for the statistical extrapolation process for overpayments. Coordinate, plan, schedule and participate in Informal Hearings with LDH, providers, attorneys, analysts and others involved in the process. Prepares for and testifies in appeal procedures before an Administrative Law Judge and appears in court as an expert witness on behalf of Medicaid. Recommend policy clarifications and changes based on observations and review findings. Perform other related duties as assigned. QUALIFICATIONS REQUIRED: Possession of a valid Louisiana Registered Nurse license to practice professional nursing. Three years of professional nursing experience or experience with claims and/or medical record auditing experience with a public and/or private insurance entity. Excellent analytical skills, effective organizational and time management skills. Excellent communication skills both oral and written. Proficient in the use of Microsoft Office products. DESIRED: Advanced Degree. Five years of professional experience with claims and/or medical record auditing experience with a public and/or private insurance entity. Five years of professional nursing experience. Three years of professional experience with Louisiana Medicaid policies, publications and rules. Professional industry auditing certification (CPC, CPMA, CIC, CFE) and/or other medical certification. SALARY: 75-85k 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. Posting Close Date This position will remain open until filled. 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. About LSU New Orleans LSU New Orleans is the only R2 public research university in New Orleans, Louisiana, and one of just four public colleges in Louisiana to hold that designation. R2 status opens the doors to competitive federal research grants that flow preferentially to classified research universities. It anchors the university’s power to recruit research-active faculty, to sustain doctor programs of national standing, and to signal to businesses and investors that New Orleans possesses the intellectual infrastructure a knowledge economy demands. Located along Lake Pontchartrain in New Orleans, LSU New Orleans’ research excellence and urban relevance provide an opportunity for the institution to become a leading public research partner in one of America’s most exciting and vibrant metropolitan areas. New Orleans has always faced challenges that call for research driven solutions including coastal land loss, educational achievement gaps, affordability, public safety, and workforce shortages. LSU New Orleans can strengthen its research activity as a tool for public problem solving as well as economic impact by leveraging the scale, reputation, infrastructure, and global reach of the LSU enterprise while remaining deeply connected to the city it serves. With more than 5,500 students and the support of approximately 248 faculty serving the College of Liberal Arts & Human Development, The college of Sciences, The Robert A. Savoie College of Engineering, the Henry Berstein College of Business Administration, and six distinct schools, the campus remains committed to honoring its founding vision and continuing to play a critical role in the region. Opened in 1958 on the site of a former U.S. Naval Air Station as the region’s first fully integrated public university, LSU New Orleans was created after years of coordinated efforts from civic leaders and residents who believed that an accessible public institution of higher education was vital to the city’s future. Located only 15 minutes away from downtown and the French Quarter, the university occupies a 195-acre campus in one of the nicest residential areas of the city.Since its first commencement exercises in 1962, the university has conferred more than 80,000 degrees creating an extensive network of Privateer Alumni that includes prominent local leaders in fields such as business, tourism, athletics, government, and academia. The university is also an important catalyst of socio-economic mobility for the region. Its student body includes a significant share of first-generation students, working students, adult learners, and veterans.The institution has grown from a commuter-oriented campus into a comprehensive urban research university with undergraduate, graduate, and doctoral programs in distinctive academic categories tied to the city and region. Its evolution has been inseparable from the story of New Orleans; an internationally recognized city of creativity, resilience, industry, cultural influence, and global connectivity. As one of the most strategically important cities in America, New Orleans’s economy is rooted in legacy sectors such as energy, maritime commerce, tourism, healthcare, and international trade. Recently, the city has expanded its economic portfolio to include areas such as coastal restoration, film and media production, technology, and advanced manufacturing. The city’s strengths are the university’s opportunities. New Orleans needs talent, civic leadership, resilient infrastructure, healthcare innovation, artists, and entrepreneurs. This combination of culture, commerce and connectivity gives LSU New Orleans a set of dynamic factors that allows it to serve as both an access institution and a problem-solving university as it reinvents itself beginning this summer. LSU New Orleans Welcomes Job Applicants from Varied Backgrounds 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.

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