Special Investigator

Arizona Department of Administration • Phoenix, AZ

12d • 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. Special Investigator Office of Inspector General (OIG) Job Location: Address: 150 North 18th Avenue Phoenix, Arizona 85007 All AHCCCS Employees must reside within the state of Arizona Posting Details: Salary: $49,500 - $53,840 Grade: 21 FLSA Status: Non-Exempt This position will remain open until filled. Job Summary: 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

• Law Enforcement processes and protocols, basic investigative techniques
• Interviewing suspects, witnesses and victims, and of the rules regarding the admissibility of statements, admissions and confessions
• Thorough knowledge of HIPAA and the rules pertaining to the sharing of investigative information
• Relevant statutes and laws pertaining to the investigation of Medicaid fraud, waste and abuse
• Income and resource requirements for eligibility for each of these varied programs, Arizona Revised Statutes, State Personnel Rules
• Computerized AHCCCS and the Arizona Department of Economic Security (DES) mainframe systems to effectively extract relevant information
• Microsoft Windows, Word and Excel, with the ability to prepare detailed spreadsheets to show how the fraud and accompanying loss of funds to the program was occurred
• AHCCCS divisions, the services they provide and how they interact with other divisions
• Legal decisions as they relate to the admissibility of evidence, confessions, admissions and statements
• Research methodologies, independent working skills (requiring minimal supervision)
• Proper methods of interviewing suspects, witnesses and victims, and of the rules regarding the admissibility of statements, admissions and confessions
• Effective methods to conduct a covert surveillance operations to identify fraudulent activity
• Investigative methods, techniques, and approaches, necessary to plan and conduct criminal, civil and administrative investigations relating to the operations and activities of AHCCCS
• Communicate effectively with stakeholders under adverse arid threatening circumstances.
• Work within a virtual team environment to function effectively in an orderly and purposeful manner in situations of stress or tension
• Interpret and apply Federal and State Statutes and Agency policies
• Ability to understand the investigative process and apply agency standards
• Manage time effectively
• Keep Personal Health Information (PHI), Health Information Portability and AccountabilityAct (HIPAA), and internal state employee cases confidential
• Work independently in a virtual office environment with little oversight
• The ability to learn and navigate a multitude of agency specific software/programs (PMMIS, HEA, AZTECS, OnBase, etc.)
• Present yourself in a calm and professional manner when dealing with difficult and hostile situations
• Drive a state vehicle
• Ability to travel within the State of Arizona to conduct field investigations, which includes home visits and interviews
• Attend in-person meetings, trainings, and other required functions in the Phoenix office
• Arizona Driver's License.
• 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.

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