Healthcare Auditor & Compliance Lead

State of Georgia; High Springs (FL); On-site; USD 53,000 - 74,000; Full time

Job summary

The State of Georgia, Department of Community Health seeks an Auditor 3 to conduct medical reviews and ensure compliance with SHBP policies. You will evaluate nursing standards, apply coding principles, and coordinate with divisions to monitor fraud, waste, and abuse across health programs.

Responsibilities include performing risk assessments, drafting narratives, and leading special projects related to payment integrity and regulatory compliance.

Qualifications

• Requires knowledge of nursing standards and protocols
• Experience with health care programs and SHBP policies
• Excellent report writing and communication skills
• Ability to interpret guidelines and policies
• Strong teamwork and independent problem solving

Responsibilities

• Conducts medical reviews following Office of Audits guidelines
• Evaluates nursing standards and nurse protocols for medical reviews
• Uses coding principles per AMA and health statistics standards
• Directs quality improvement activities for compliance
• Coordinates with divisions to monitor Fraud, Waste, and Abuse

Skills

Auditing skills

Fraud detection

Regulatory knowledge

Review and analysis

Interpersonal communication

Education

MS in Nursing, Psychology, Healthcare Administration

Accounting or Business-related degree

Job description

The State of Georgia, Department of Community Health seeks an Auditor 3 to conduct medical reviews and ensure compliance with SHBP policies. You will evaluate nursing standards, apply coding principles, and coordinate with divisions to monitor fraud, waste, and abuse across health programs.

Responsibilities include performing risk assessments, drafting narratives, and leading special projects related to payment integrity and regulatory compliance.