Auditor 3

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 conducts complex criminal and civil investigations relating to allegations of Medicaid eligibility fraud, including determining the loss to the AHCCCS program. The responsibilities of this position include but are not limited to: In-depth research investigative report writing, researching Medicaid eligibility rules, policies, statutes. Preparing documentation for eligibility determinations, criminal prosecutions and administrative hearings.

Requirements

• At least two years of experience as an auditor, investigator or equivalent, or eligibility or case worker experience, which includes Medicaid or other public benefits financial policy background.
• Arizona Driver's License.

Nice To Haves

• CFE Certification, Bachelor’s Degree in Accounting, Healthcare, Criminal Justice or related field, or 4 years of eligibility or case worker experience, which includes Medicaid or other public benefits financial policy background.
• Knowledge of proper methods of interviewing suspects, witnesses and victims, and of the rules regarding the admissibility of statements, admissions and confessions, and Title 19, ARS 13 and 36.

Responsibilities

• In-depth investigative work to include desk level gathering of evidence, interviewing members and witnesses, observing and documenting pertinent information, gathering data, developing sources of information, and conducting surveillance. As needed, travel within the State of Arizona to conduct field investigations.
• Utilizing investigative information to write a substantive reports to substantiate allegations of Medicaid fraud for eligibility determinations, including determining the loss to the AHCCCS program, for criminal prosecution, civil actions, and/or administrative hearings.
• Compile, analyze and organize Medicaid eligibility records, financial records and other related documents, such as marriage records, real estate records, corporate filing records and various database records, to assess the accuracy of eligibility applications.
• Calculate expenditures associated with fraud, waste and abuse to determine cost-benefit analysis for potential prosecution, civil actions and/or administrative hearings.
• Conduct investigative Internet searches, use and interpret other investigative sources such as; ACJIS, Experian Credit Reports, CLEAR, TLO, Vital Records, Arizona Corporation Commission records and Arizona Motor Vehicle Division reports, etc.
• Interpret and apply federal and state regulations, agency rules, and various agency and state policy manuals to make appropriate eligibility determinations.
• Participate and testify in the appeals grievance process, coordinate with prosecution agencies, and provide Grand Jury and Court testimony.
• Participate in special projects that may include out-of-town / overnight travel involving residency/eligibility checks of participants, as well as participate in special projects, such as on-site audits of certain high risk Medicaid providers.
• Attend in-person trainings and meetings in the Phoenix office.
• Prepare and serve subpoenas to obtain evidence necessary to prove or disprove allegations of Medicaid Fraud.

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
• Education Level: No Education Listed
• Number of Employees: 501-1,000 employees