Compliance Specialist 3
The Georgia Department of Community Health (DCH) is currently seeking qualified applicants for the position of Compliance Specialist 3, in the Office of Inspector General, Program Integrity Unit. The position provides critical support functions within the ProgramIntegrity Unit and the Office of Inspector General, which helps safeguard the agency from fraud, waste, and abuse. The selected candidate will serve as 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.
Job 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.
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.
Preferred Qualifications:
- 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
Additional Information
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.
