Medicaid Investigations Manager – Program Integrity

State of Georgia; Atlanta (GA); On-site; USD 56,000 - 80,000; Full time

Job summary

State of Georgia, Department of Community Health, is seeking an Investigations Manager to oversee the Program Integrity Unit and Office of Inspector General. The role directs two direct reports and leads investigations into fraud, waste, and abuse within the Fee-for-Service Medicaid program across Georgia.

The manager analyzes claims data to identify aberrant billing and leads on-site investigations, records requests, and interviews, ensuring timely adherence to performance metrics and providing

Qualifications

• Bachelor's degree in operations management, business administration, or related field with at least 3 years in a managerial role.
• Seven years of related professional experience with at least 3 years in a managerial role.
• Equivalent combination of education and experience may be substituted per policy.

Responsibilities

• Manage two direct reports investigating providers for fraud, waste, and abuse in Medicaid.
• Analyze claims data to identify aberrant billing trends for utilization review.
• Conduct on-site provider visits across Georgia to request medical records and inspect facilities.
• Review documentation for Participant and Consumer Directed Care services to investigate false claims.
• Review referrals and hotline complaints and participate in Surveillance Utilization Review meetings.

Skills

Managerial experience

Supervisory leadership

Data analysis

Education

Bachelor's degree in operations management, business administration, or related field

Job description

State of Georgia, Department of Community Health, is seeking an Investigations Manager to oversee the Program Integrity Unit and Office of Inspector General. The role directs two direct reports and leads investigations into fraud, waste, and abuse within the Fee-for-Service Medicaid program across Georgia.

The manager analyzes claims data to identify aberrant billing and leads on-site investigations, records requests, and interviews, ensuring timely adherence to performance metrics and providing