University of New Orleans
Program Integrity SURS Clinician
Baton Rouge, La
Sponsorship not specified$75k-$85kDetected 1 day ago
ExcelAuditingICD-10ResearchCommunicationTime ManagementMicrosoft Office
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88Lottery-free
Cap-exempt (no lottery)100
Sponsors year-round90
Entry-level history60
PERM / green-card track50
Fits your clock70
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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.
Responsibilities
- 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.
Requirements
- 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.
- Applicants should fully describe their qualifications and experience with specific reference to each of the minimum and preferred qualifications in their cover letter.
- 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
Skills
- Supply information needed for the statistical extrapolation process for overpayments.
Compensation
- $75k-$85k
Benefits
- 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.
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This listing is sourced directly from University of New Orleans's careers page and normalized into a canonical job model.