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Program Integrity (MCU) - Coordinator 2
University of New Orleans
Posted 12/03/25
2000 Lakeshore Drive, New Orleans, LA 70148
Job Description
Job Summary
Job Description
- Assesses Managed Care Entity (MCE) compliance with contract deliverables.
- Reviews and assess fraud, waste, and abuse (FWA) investigation reports, referrals, and tips from MCEs.
- Identifies and investigates audit leads and risk areas within the Medicaid program.
- Plans and performs 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.
- Prepares case documents, audit summaries, and reports.
- Coordinates law enforcement requests, managed care investigations, external audit requests, referrals, tips, and complaints with MCEs, MFCU, and other Program Integrity staff.
- Maintains case lists, investigation documents, Program Integrity policies and procedures, written communications and directives sent to MCEs, and other programmatic documentation as requested.
- Recommends appropriate sanctions or corrective actions based on audit or investigation findings.
- Researches and assists with MCE contract questions; recommends contract and policy changes as needed.
- Educates providers on appropriate billing and Medicaid policy, rules, and regulations.
- Assists with data mining and other special projects at the request of LDH Program Integrity staff.
- Assists with development of reports and data dashboards to enhance MCE oversight efforts.
- Assists co-workers with questions and/or issues that arise.
- Assists with MFCU/PI/MCE meetings and communications.
- Other duties as assigned.
About University of New Orleans
Outside GNO RegionCompany ProfileA Commitment to New Orleans and Beyond
Since its founding, UNO has been committed to diversity and inclusion. In 1958, the University of New Orleans opened its doors as the first fully integrated public university in the South. For nearly 60 years, we have not strayed from that vision. The University has educated students from all 64 Louisiana parishes, all 50 states, and more than 130 countries, bringing together a variety of talented and motivated students so that they may learn, interact and pursue their career goals.
The University of New Orleans is a major business driver in metro New Orleans, generating a total economic impact of $470.5 million for metropolitan New Orleans in the 2014-15 fiscal year. As a global community asset, we offer a wide array of relevant, undergraduate and graduate academic programs and world-class research opportunities. We proudly contribute to the industry, culture and economy of the New Orleans region and beyond.
Nationally Ranked
Our students come here for a number of reasons, but on the top of that list is the high quality education we provide. We're proud to be named one of the nation's best colleges by The Princeton Review, Forbes, U.S. News & World Report and one of the top 1,000 universities in the world by the Center for World University Rankings. We are also classified by the Carnegie Foundation as a Doctoral University with Higher Research Activity, one of only two in the state of Louisiana. The University's rankings are a testament to the students we attract and the quality of our faculty.
Website
uno.edu/Social Media
