Compliance Specialist 3 (00180591)

Georgia Department of Community Health • Hybrid - Atlanta, GA

10h • Hybrid

About The Position

The Georgia Department of Community Health (DCH) is seeking qualified applicants for the position of Compliance Specialist 3, in the Office of Inspector General, Program Integrity Unit. This position provides critical support functions within the Program Integrity Unit and the Office of Inspector General, which helps safeguard the agency from fraud, waste, and abuse. The selected candidate will serve as a direct report to the Data Analytics Manager. The Compliance Specialist 3 will be responsible for the Surveillance and Utilization Review (SUR) and Deep Dive reports as well as facilitating quarterly meetings. The Compliance Specialist 3 will analyze claims data to identify aberrant billing trends for providers to facilitate utilization review. The desired candidate will collaborate with other Program Integrity staff for onsite investigations. 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.

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

Nice To Haves

• Proficient knowledge of Microsoft Office Suite Applications and Data Analysis
• Intermediate to advanced MS Word, MS Excel, MS Access, and MS Power BI
• Knowledge of Business Objects and Medicaid Management Information Systems
• Knowledge of statistical data and reporting
• Knowledge of Medicaid Policies and Procedures
• Experience working with Medicaid and/or Medicare claims
• Ability to coordinate tasks with internal and external parties
• Ability to organize documents, forms, and data
• Ability to communicate both orally and in writing
• Ability to understand governmental organizations and operations
• Strong data entry and typing skills
• Comfortable presenting findings from data analysis to a wide range of audiences through a variety of mediums
• Ability to understand and proactively identify fraud, waste, and abuse in healthcare settings

Responsibilities

• Reports to the Data Analytics Manager.
• Run Surveillance and Utilization Review (SUR) and Deep Dive reports on a quarterly basis.
• Facilitate meetings on a quarterly basis to discuss SUR reports with Program Integrity staff.
• Test/Review Ad Hoc/SUR change orders in MMIS which affect DCH OIG data sources and reports.
• Develop criteria for reports for internal and external end users.
• Perform complex data queries to facilitate claims data analysis.
• Support the review of state and federal legal cases involving the Medicaid program.
• Perform data analysis to identify patterns of suspicious behavior from providers that may lead to potential cases of fraud, waste and abuse.
• Monitor and track assigned data requests.
• Maintain and track compliance with established deadlines.
• Research data discrepancies and recommend strategies for accurate reporting.
• Research health related topics for identification of possible fraud and abuse related investigations.
• May serve as a team lead on specific projects 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