AUDITOR 2

Arizona Department of Administration • Phoenix, AZ

3d • Remote

About The Position

The Division of Business and Finance (DBF) is looking for a highly motivated
individual to join our team as an Auditor 2. This position helps coordinate all
areas of the AHCCCS Reinsurance Program as related to the contractual agreement
with the AHCCCS Managed Care Organizations (MCOs) and Program Contractors, and
reimbursement for transplant related services for nine Indian Health Services
(IHS) Fee for Service plans. This staff member will determine compliance with
contractual agreements for Reinsurance consideration for acute, catastrophic and
transplants.

This position may offer the ability to work remotely, within Arizona, based upon
the department's business needs and continual meeting of expected performance
measures.

The State of Arizona strives for a work culture that affords employees
flexibility, autonomy, and trust. Across our many agencies, boards, and
commissions, many State employees participate in the State’s Remote Work Program
and are able to work remotely in their homes, in offices, and in hoteling
spaces. All work, including remote work, should be performed within Arizona
unless an exception is properly authorized in advance.

Requirements

• AHCCCS Reinsurance Policy and Procedures
• AHCCCS Contracts for MCOs, Program Contractors and Fee for Service
• Knowledge of principles and practices of auditing and accounting
• Demonstrated experience with claims, encounters or ICD-9 or 10 coding
• Policies and Procedures established for the work system
• Prepaid Medical Management Information System (PMMIS) Reinsurance sub-system
• AHCCCS Encounter processing
• Health Insurance Portability and Accountability Act (HIPAA) requirements as related to the AHCCCS Reinsurance Program
• Coding as related to Current Procedural Terminology (CPT), Health Care Financing Administration Common Coding System (HCPCS), International Classification of Diseases (ICD-10)
• Working knowledge of Microsoft Office and Other Software: Cognos, Excel, Google Docs/Sheets and Google Mail
• Techniques of complex research
• Techniques of complex research
• Demonstrated skills in auditing
• Strong customer service skills
• Excellent interpersonal, written, oral communication
• Demonstrated experience working in the PMMIS system
• Applying and interpreting federal and state laws, rules and policies as they pertain to program operations and activities
• Applying claims auditing methods and techniques
• Demonstrated ability to balance, prioritize and organize multiple tasks, work collaboratively in teams
• Work under limited supervision
• Prioritize projects
• Experience in auditing work, principles, standards and technique.

Nice To Haves

• Bachelor's degree in accounting or closely related field.

Responsibilities

• Audit PMMIS encounters and reinsurance payments to ensure that they are appropriately encountered by the contractor and processed. Use knowledge of coding and claims as well as AHCCCS Reinsurance processing rules to assist the Contractor, when necessary, in identifying impediments to processing though PMMIS.
• Audit critical monthly reports to ensure contractors program compliance and make necessary recommendations when needed.
• Audit, Research and Adjudicate Reinsurance claims based on interpretation of AHCCCS Policies, Procedures and Contracts and laws.
• Audit and Process Catastrophic & Transplant Reinsurance cases for adjudication and payment.
• Communicate with internal and external personnel on a daily basis including by phone or email. Provide technical system/training support to external and internal users including assisting with annual training conducted by the reinsurance team.
• Develop and analyze a variety of data warehouse reports and Excel workbooks for paid adjudicated encounters and reinsurance payments to ensure that encounters are properly submitted by the contractor and processed so that they will be included in the data used by actuaries when developing managed care capitation rates.
• Provide technical system/training support to external and internal users. assist with Technical Assistance to MCOs and participate in the annual Contractor Workshop.
• Recommend system changes/enhancements to comply with contracts.

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: Mid Level
• Number of Employees: 501-1,000 employees