Auditor 3 (00191774)

Georgia Department of Community Health • Hybrid - Atlanta, GA

2d • Hybrid

About The Position

The Georgia Department of Community Health (DCH) is seeking qualified candidates for an Auditor 3 position with the DCH's Office of the Inspector General. This is a hybrid position that requires in-office and remote work with the approval of your supervisor. Your days of frequency in the office can change at any time during your employment based on the business needs of the organization. DCH serves as the lead agency for Medicaid, oversees the State Health Benefit Plan (SHBP) and Healthcare Facility Regulation, impacting one in four Georgians. DCH is committed to providing superior Customer Service and Communication, embracing Teamwork and fostering Accountability to ensure that our internal and external customers and stakeholders feel included, respected, engaged and secure.

Requirements

• High school diploma/GED and four (4) years of job-related experience; or Associate degree in a related field from an accredited college or university and five (5) years of job-related experience or four (4) years of related professional experience; or two (2) years of experience required at the lower level Complnc Specialist 2 (RCP061) or position equivalent.
• Applications without work experience listed will not be considered.

Nice To Haves

• Some positions may require a certification or licensure.
• Some positions may require a valid driver's license.

Responsibilities

• Conducts medical reviews and ensures the reviews are consistent with Office of Audits guidelines and in compliance with SHBP policies.
• Evaluates nursing standards and nurse protocols for all medical reviews.
• Utilizes coding principles in accordance with American Medical Association, National Center for Health Statistics and World Health Organization.
• Review state, federal, and other regulatory standards to direct quality improvement activities and achieve compliance.
• Coordinates with Divisions within the agency to effectively monitor Fraud, Waste, and Abuse.
• Collaborate with contracted vendors and staff to ensure SHBP providers are following SHBP policies and procedures, state, and federal laws.
• Track and monitor monthly and quarterly reports to ensure oversight of SHBP vendors' Special Investigation Unit activities identified in contracts.
• Participates in the planning, coordination, development and implementation of long-range goals and objectives for the Office of Inspector General.
• Coordinates on site visits at provider locations to facilitate utilization reviews.
• Effectively communicates with external and internal stakeholders at monthly meetings to mitigate fraud, waste, and abuse in the SHBP.
• Leads special projects and participates in audits to ensure payment integrity of claims billed to SHBP.
• Performs claims data analysis to identify aberrant billing trends for providers enrolled in SHBP.
• Collaborates with Audit Supervisor and Director to detect, prevent, and investigate providers for fraud, waste, and abuse.
• Conduct performance, operational, financial and/or compliance audit projects.
• Perform thorough and accurate risk assessments effectively scoping engagements.
• Ensure working papers are clear, concise, and accurate; work papers are prepared in accordance with applicable standards and Department policies and procedures and are well organized.
• Plan projects in a clear, logical and reasonable manner; ensure effective use of resources.
• Establish the appropriate methodology for the audit based on the objectives of the audit.
• Analyze audit documentation including financial statements, budgetary compliance reports, and claims data.
• Conduct interviews and walkthroughs to assist in the evaluation of internal controls.
• Write narratives and conclusions based on the findings derived from the audits.
• Organize audit work according to policies and procedures.
• Assist and prepare manuscripts and reports.
• Communicate audit and compliance information such as results and conclusions in accordance with professional standards and the Department policies and procedures.
• Perform other duties as assigned.

Benefits

• employee retirement plan
• paid holidays annually
• vacation and sick leave
• health, dental, vision, legal, disability, accidental death and dismemberment, health and child care spending account.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED