Clinical Auditor

3 weeks ago

Atlanta, Georgia, United States State of Georgia Full time
Job Description

The State of Georgia is seeking a highly skilled Clinical Auditor to join our team in the Medicaid Fraud Division. As a key member of our Audits section, you will be responsible for conducting thorough audits of medical records and claims data to identify potential instances of healthcare fraud. This is an exciting opportunity to use your expertise in medical auditing to make a real difference in the lives of Georgians.

Responsibilities

* Conduct thorough audits of medical records and claims data to identify potential instances of healthcare fraud
* Collaborate with investigators to develop strategies for investigating and prosecuting healthcare fraud cases
* Develop and maintain a comprehensive understanding of current policies and procedures governing the Georgia Medicaid Program
* Participate in interdisciplinary teams to investigate complex healthcare fraud cases
* Prepare written reports and summaries of findings

Requirements

* Current RN license in the State of Georgia
* Demonstrated experience in the analysis of Medicaid/Medicare claims
* Strong analytical and problem-solving skills
* Excellent communication and interpersonal skills
* Ability to work independently and as part of a team

Salary

$70,000 - $95,000 per year, depending on experience.

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