Investigations Manager

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Job Title: Investigations ManagerAgency: Department of Community Health Job Requisition ID: JR0000004059Shift: Not Applicable (United States of America)Compensation Details: $56,310.72 - $80,000 Job Description: The 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 be responsible for managing two (2) direct reports charged with investigating providers for fraud, waste, and abuse in the Fee-for-Service Medicaid program. The Investigations Manager provides guidance and feedback to the team to ensure adherence to performance metrics and timeliness of business processes for the Program Integrity Unit. The Investigations Manager analyzes claims data to identify aberrant billing trends for providers to facilitate utilization review. The Investigations Manager conducts and leads provider on sites throughout Georgia to request medical records, conduct interviews, and tour facilities to ensure appropriate medical equipment is onsite to support services billed to Medicaid. The Investigations Manager reviews documentation for Participant and Consumer Directed Care services to investigate allegations of false claims billed to Medicaid. The Investigations Manager reviews referrals, hotline complaints, and participates in Surveillance Utilization Review meetings to identify providers for utilization review

Minimum Qualifications: Bachelor's degree in operations management, business administration, or a related field which includes three (3) years in a managerial or supervisory role; or seven (7) years of related professional experience which includes three (3) years in a managerial or supervisory role; or three (3) years of experience required at the lower level Mgr, Business Ops (GSM010) or position equivalent.--Note: An equivalent combination of knowledge, education, job or intern experience, training, or certifications that provides the necessary knowledge and skills to successfully perform the job at the level listed may be substituted year-over-year. Equal Employment Opportunity Employer The State of Georgia does not discriminate based on race, color, national origin, sex, religion, age, disability, or other protected categories in employment or the provision of services. Qualified applicants may request reasonable accommodation when needed during the application and/or screening process by contacting the appropriate agency Human Resources department.