Auditor 3 (00191774)
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Apply to Auditor 3 (00191774) at Georgia Department of Community HealthJob details
- Location
- Atlanta, Georgia
- Work type
- Hybrid
- Compensation
- $53,311 - $73,677/yr
- Posted
- yesterday
- Apply on
- governmentjobs.com
About this role
About the Department
The Georgia Department of Community Health (DCH) is one of Georgia's four health agencies serving the state's growing population of over 10 million people. DCH serves as the lead agency for Medicaid, oversees the State Health Benefit Plan (SHBP) and Healthcare Facility Regulation, impacting one in four Georgians.
Through effective planning, purchasing and oversight, DCH provides access to affordable, quality health care to millions of Georgians, including some of the state's most vulnerable and under-served populations. Six enterprise offices support the work of the agency’s three program divisions. DCH employees are based in Atlanta, Cordele and across the state.
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.
The Department of Community Health 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.
Position Duties
•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
Minimum Qualifications
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. Note: Some positions may require a certification or licensure.
Note: Some positions may require a valid driver's license.
Other Qualifications
EARN MORE THAN A SALARY! In addition to a competitive salary, the Georgia Department of Community Health offers a generous benefits package, which includes 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.
Due to the volume of applications received, we are unable to provide information on application status by phone or e-mail. All qualified applicants will be considered, but may not necessarily receive an interview. Selected applicants will be contacted by the hiring agency for next steps in the selection process. Applicants who are not selected will not receive notification.
THIS POSITION IS SUBJECT TO CLOSE AT ANY TIME ONCE A SATISFACTORY APPLICANT POOL HAS BEEN IDENTIFIED. APPLICATIONS WITHOUT WORK EXPERIENCE LISTED WILL NOT BE CONSIDERED. CURRENT GEORGIA STATE GOVERNMENT EMPLOYEES WILL BE SUBJECT TO STATE PERSONNEL BOARD (SPB) RULE PROVISIONS. THE POSITION MAY BE FILLED AT A LOWER OR HIGHER POSITION LEVEL.
This position is unclassified and employment is at-will. Candidates for this position are subject to a background history, reference check, and credit check. For more information about this job contact: : http://dch.ga.gov
Benefits
In addition to a competitive salary, we offer a generous benefits package that includes a flexible schedule, training opportunities, employee retirement plan, deferred compensation, 13 paid holidays, vacation & sick leave, dental, vision, long term care, and life insurance.
Supplemental Questions
- Yes
- No
- Juris Doctorate
- Master's Degree
- Bachelor's Degree
- Associates Degree
- Some College/Tech School
- High School Diploma
- GED
- None of the above
- No
- Full Time Employee
- Part Time Employee
- Temp or Contractor
- Intern
- Volunteer
- None
- Less than 1 year
- 1yr to less than 2yrs
- 2yrs to less than 3yrs
- 3yrs to less than 4yrs
- 4yrs or more
- None
- Less than 1 Yr
- 1 Yrs to less than 2 Yrs
- 2 Yrs to less than 3 Yrs
- 3 Yrs to less than 4 Yrs
- 4 Yrs or More
- Yes
- No
Required Question
Agency Information
EmployerGeorgia Department of Community HealthAddress 2 M.L.K. Jr. Drive SE, 18th FloorAtlanta, Georgia, 30334 Website http://www.dch.georgia.gov