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5 Apr 2019

Full-Time Compliance Specialist 3 -00056268

Department of Community Health – Posted by DCHHR Anywhere

Job Description

The Georgia Department of Community Health (DCH) is one of Georgia’s four health agencies serving the state’s growing population of almost 10 million people. DCH serves as the lead agency for Medicaid and oversees the State Health Benefit Plan (SHBP), Healthcare Facility Regulation and Health Information Technology in Georgia for one in four Georgians.  Through effective planning, purchasing and oversight, DCH provides access to affordable, quality health care to millions of Georgians, including some of the state’s most vulnerable and under-served populations. Six enterprise offices support the work of the agency’s four program divisions. DCH employees are based in Atlanta, Cordele and across the state.

DCH is currently seeking a qualified Compliance Specialist 3 in the Office of Inspector General, Program Integrity/ Data Integrity & Analysis unit.

  • Conducts desk and on-site reviews, audits, or surveys of clinical and treatment facilities, regulated entity operations and program management
  • Conducts utilization reviews, peer reviews, evaluation activities, and all other reviews on a scheduled basis
  • Coordinates investigations involving noncompliance in facilities, community programs, regulated entity operations and other related programs
  • Coordinates the data management and quality assurance functions
  • Determines compliance with applicable state and/or federal rules and regulations
  • Develops, implements and evaluates the surveillance of utilization review to monitor and evaluate quality services
  • Monitor, tracks, and maintains record on compliance
  • Plan and evaluates outcome studies and/or compliance findings
  • Plan, develops, schedules and implements survey and complaint investigations for licensure or certification of regulated facilities
  • Recommends programmatic and/or operational changes based on review, audit or survey results
  • Researches and analyzes state codes, federal regulations and industry manuals regarding forms, policies and procedures
  • Reviews applications for accuracy and compliance with guidelines, regulations and laws
  • Performs investigations and/or audits according to established rules, regulations and other statutes.

Master’s degree in a related field from an accredited college or university AND Two years of related experience OR Bachelor’s degree in a related field from an accredited college or university AND Four years of related experience OR Associate’s degree in a related field from an accredited college or university AND Five years of experience, Two years of which in a position directly related to the area of assignment OR Two years of experience required at the lower level Compliance 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: Preference will be given to candidates who, in addition to meeting the qualifications listed above, demonstrate some or all of the following skills/experience/knowledge:

  • Active Licensed Registered Nurse with two years of experience in utilization review and/or quality improvement.
  • ICD-9 & ICD coding experience
  • CPT/HCPCS coding experience
  • Knowledge of hospital coding- Diagnostic Related Grouping (DRG) or Ambulatory Procedure Coding (APC)
  • Proficient using Microsoft Office (Excel, Access, etc)

Current Georgia state government employees will be subject to SPB rule provisions.  The position may be filled at a lower or higher position level.


Please visit the DCH jobsite link to review the job posting and apply:

Applicants who do not apply using the dchjobs link provided above will NOT be considered.

For other DCH career opportunities,

please visit:

Job Categories: Registered Nurse Jobs. Job Types: Full-Time. Salaries: 40,000 - 60,000.

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