University of New Orleans

Program Integrity SURS Clinician

Baton Rouge, La

Sponsorship not specified$75k-$85kDetected 9 days ago

ExcelAuditingICD-10ResearchCommunicationTime ManagementMicrosoft Office

About the role

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.
Work with applicable program management staff, contract staff and other staff from agencies involved in case reviews and investigations.

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.
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.
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.
Please upload the following documents in the Resume/Cover Letter section.

Advanced Degree.
Three years of professional experience with Louisiana Medicaid policies, publications and rules.
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.
Cover Letter indicating why you are a good fit for the position and LSU New Orleans;
Required Attachments
Applications that do not include the required uploaded documents may not be considered.
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.
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.
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.
Professional industry auditing certification (CPC, CPMA, CIC, CFE) and/or other medical certification.
SALARY: 75-85k

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.
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.

Supply information needed for the statistical extrapolation process for overpayments.

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.
Collaborate with a variety of medical consultants relative to questionable billing practices related to medical necessity of services.

This listing is sourced directly from University of New Orleans's careers page and normalized into a canonical job model.