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 will perform audits/investigations on Fee For Service and Managed Care Organization business providers to establish if program violations have occurred through billing, medical health records, and financial documentation. The position is responsible for reviewing items of evidence and making a determination as to whether a provider has committed fraud. 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

• At least two years' experience as an Auditor, investigator or equivalent; Bachelor's Degree in Accounting, Healthcare, Criminal Justice or related field.
• Arizona Driver License
• Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
• All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

Nice To Haves

• CPC, CFE Certification, or Medical or Health Care financial background, or 4 yrs of eligibility experience, or a 4 year degree from accredited university in a closely related field.
• 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, ASRS 13 and 36.

Responsibilities

• Conduct internal and external audits/investigations pertaining to AHCCCS FFS, AIHP, 638/IHS, TRBHA, FQHC and MCO business regarding provider allegations and/or to verify program of integrity in all aspects of OIG to ensure compliance and integrity (analyze claims, encounter data, review medical records, conduct on-site visits, record interviews, produce high level reports, audit related correspondence, CMP's).
• Research Policy and procedures, statutes and changes to Medicaid/Medicare as it relates to compliance, in particular changes to AHCCCS FFS, AIHP, 638/IHS, TRBHA, FQHC, and MCO's.
• Analyze and interpret data to effectively communicate the audit results.
• Assist in the review and tracking of Corporate Compliance Deliverables for FFS/AIHP/MCO
• Produce high level reports and correspondence for internal and external customers; such as Executive Management, Internal AHCCCS Divisions and overpayment reports with losses to the medicaid program for both internal purposes and external, such as; lawyers, MFCU/AG's office.
• Conduct interviews and obtain written statements from AHCCCS providers, and clients as it relates to audit/ investigations.
• Other duties as assigned as related to the position (typically 5% - 10%)

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