Auditor 2

Arizona Department of Administration • Phoenix, AZ

1d • Hybrid

About The Position

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid Agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry. Come join our dynamic and dedicated team. This position is responsible for conducting investigations to evaluate the accuracy of eligibility determinations for State and Federal programs to prevent ineligible applicants from being approved and discontinuing members who are ineligible to receive benefits.

Requirements

• Claims reporting activity
• Microsoft Windows software, Excel spreadsheet software, basic understanding of data base software
• Medicaid Programs and Prepaid Medical Management Information System (PMMIS) and/or DES Eligibility System (AZTECS)
• State statutes, rules and regulations relating to the determination of eligibility for AHCCCS programs, legal and technical terminology for the interpretation of highly diverse forms of verification including, but not limited to, divorce decrees, county property assessment records, medical records, hospital billings, life insurance policies, public assistance benefits and self-employment records
• Analyzing case records, evaluation and interpretation of written and verbal information, troubleshooting and problem-solving skills
• Research methodologies, independent working skills (requiring a minimum of supervision)
• Interviewing techniques to elicit information
• Verbal and written communication, basic computer skills
• Interpersonal relations as applied to contact with benefit recipients, landlords, employers, public and private organization representatives
• Use of tactful diplomacy due to the nature of the job
• Work within a team environment, function effectively in an orderly and purposeful manner in situations of stress or tension
• Work with the public in less-than-ideal conditions
• Deal with difficult situations in a calm manor
• Effectively handle hostile situations
• Drive a state vehicle
• Deal with multiple tasks at one time
• Successfully work and be productive in a virtual environment
• Work independently at times with little oversight
• Travel within the State of Arizona to conduct field investigations, which includes home visits and interviews
• Attend in person trainings and meetings in the Phoenix office
• Arizona Driver's License.
• Experience in investigations, auditing work or public benefits eligibility.

Nice To Haves

• Bachelor’s degree in accounting, Healthcare, Criminal Justice or closely related field.
• Experience of the rules regarding the admissibility of statement, and confessions; Title 19 and ASRS title 13 & 36.
• Bilingual (Spanish) is a plus.

Responsibilities

• Investigative work to include desk level gathering of evidence and as needed, traveling within the State of Arizona to conduct field and/or desk investigations involving AHCCCS members which includes interviewing members, observing and documenting pertinent information, gathering data and developing sources of information. Utilizing investigative information to write a substantive report that includes evidence review, factual documentation and providing a conclusion that supports or denies a member's eligibility.
• Review and assess information in the case record; analyze data obtained from all sources, case development, assessing the accuracy of the application, determining expenditures for cost benefit analysis and writing investigative summaries and will participate as a witness in the DES grievance process when an investigation was conducted, applicant was ineligible, case denied, and the applicant filed an appeal.
• Planning, scheduling, prioritizing work activity; set up workload controls, determine priorities, monitor activity progress, set goals
• Studying statutes, rules, policy manual and clarifications, attending training and conferring with supervisor and others to improve skills and maintain expert level of knowledge.
• Participate in special projects that may include out of town travel involving residency/eligibility checks of participants as well and on-site audits of certain high risk Medicaid providers. Attend in person trainings and meetings in the Phoenix office.

Benefits

• 10 paid holidays per year
• Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child.
• Other Leaves - Bereavement, civic duty, and military.
• A top-ranked retirement program with lifetime pension benefits
• A robust and affordable insurance plan, including medical, dental, life, and disability insurance
• Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
• RideShare and Public Transit Subsidy
• A variety of learning and career development opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Number of Employees: 501-1,000 employees