AHCCCS

Address: 801 E. Jefferson Street, Phoenix, AZ 85034

All AHCCCS Employees must reside within the state of Arizona.

Salary: $95,000 - $104,500

Grade: 25

Position will remain open until filled.

Under the direction of the Deputy Assistant Director (DAD) and the Inspector General (IG), the Audit Manager exercises direct oversight of Member Compliance by providing assistance, guidance and direct supervision to the three supervisors and their teams. In addition, the Audit Manager provides updates to executive management on a variety of administrative and management issues, projects, initiatives and member related investigations involving healthcare fraud, waste or abuse. The Audit Manager is responsible for ensuring the investigative supervisors and teams are exercising best practices in member healthcare fraud investigations; determining criminal culpability and submitting cases for prosecution and working towards civil remedies when there is no criminal act. The Audit Manager will ensure applicable policies and procedures are followed, updated as needed and communicated with the Member Compliance staff for input.

Major duties and responsibilities include but are not limited to:
• Manages audit supervisors of Member Compliance Unit; reports to DAD and IG in regards to asset utilization, investigation(s) status and audit results; recommends changes in operations, policies, procedures when necessary; communicates financial activities, savings and recoupments based on unit activities. Works directly with a prosecutorial agency and AHCCCS Office of General Council (OGC) in the furtherance of a criminal investigation.
• Interaction with OIG DAD, IG, AHCCCS Divisions or other State Agencies on projects and initiatives, audits, investigations and/or member/beneficiary status. Participates in the development of AHCCCS OIG annual goals and objectives, policy updates, external audit requests and provides input for system modernization and design. Communicates high level ideas, needs and operational input stemming from meetings, training, or projects
• Final review of Member Compliance Units Report of Investigations, and documents that support the final outcome to ensure the evidence is consistent and supportive to the case itself.
• Negotiate final determination of overpayment, CMP's and settlements, forfeitures with DAD and IG approval and signature.
• Mentor, develop and train subordinates; ensure planners align with the Strategic Plan, Mission, and AMS. Guide staff to understand AMS, and update as necessary the Leader Standards. Review direct staff's position descriptions and update as needed.
• Coordinate liaisonships internally and externally.

Knowledge:
• Medical health care operations and rules, to include eligibility, concerning the proper handling and accounting of patient trust accounts
•Regulations that apply to the various providers who contract with AHCCCS
• Rules of evidence
• Basic financial and accounting principles
• Criminal, civil, and administrative law; Federal Medicaid/Medicare statutes, rules and regulations as they relate to Title19; United States Code and Arizona Revised Statutes; Title 13 and 36
• Preparation of detailed computerized spreadsheets
• Computerized AHCCCS and Arizona Department of Economic Security (DES) mainframe systems to effectively extract relevant information
• Various types of eligibility programs including but not limited to: Social Security Disability, Long Term Care program, Supplemental Security Income, Temporary Assistance to Needy Families (TANF) program, and the Sixth Omnibus Budget Reconciliation Act (SOBRA); Specific knowledge including the income and resource requirements for each of these varied programs
• Proper methods of interviewing suspects, witnesses and victims, and of the rules regarding the admissibility of statements, admissions, and confessions
• State Personnel Rules, EEO and ADA familiarity

Skills:
• Investigative process - specifically investigating fraud, healthcare fraud and various fraud schemes; understanding the Arizona prosecution system to include the AZ Attorney General and the County Attorney systems
• Computing, summarizing, and aggregating qualitative and quantitative data in an accurate and timely manner
• Developing and using spreadsheets and other software tools
• Microsoft Office
• Interpreting and applying federal and state laws, rules, regulations, and procedures
• Organizing, documenting and preparing investigative reports
• Working with Metrics and understanding LEAN process/AMS
• Written and verbal communications
• Interpersonal skills and ability to create relationships with outside agencies and personnel
• Support IG with the OIG's Annual Strategic Plan
• Conducting investigation and audit data analysis
• Communication - verbal and written forms of communication that convey an accurate message. • Ability to foster cooperation through effective communication skills

Abilities:
• Motivate people and work within a team environment
• Clearly state what is expected so that there will be no misunderstandings among employees
• Function effectively in an orderly and purposeful manner in situations of stress or tension
• Think analytically, research and analyze data
• Deal with multiple tasks at one time; See/ listen to multiple sides of an issue
• Understand interview and investigative methodology and how to apply it to an investigation to clearly and succinctly state what the problem is, and backed up by evidence to support allegation(s)
• Team build. Aptitude to positively affect morale and create a cohesive team
• Honesty, forward looking, competent and enable others to act appropriately
• Speak publicly and testify
• Assist, advise, support, and move forward the IG's vision, goals, and objectives
• Collaborate and coordinate with peers related to working with the IG and supporting the strategic direction of the IG
• Learn AMS process; LEAN metrics; Leader Standards; Gemba Walks; and Huddle Boards
• Travel when needed for training and investigations

Arizona Driver's License.

Minimum:
• Two years experience as an Auditor Supervisor or Manager or closely related field.

Preferred:
• Three or more years experience providing direct supervision and overseeing daily activities of a section (or) Degree in Criminal Justice or related field or Certified Fraud Examiner (CFE) Certification, or Certified Professional Coder (CPC) and two or more years of responsible investigative experience preferably in government, healthcare, law enforcement, insurance, or managed care organization.

• 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.

• Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.)

If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements.

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

Among the many benefits of a career with the State of Arizona, there are:
• 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. Learn more about the Paid Parental Leave pilot program here.
• 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

By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

Learn more about the Paid Parental Leave pilot program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Lifetime Pension Benefit Program
• Administered through the Arizona State Retirement System (ASRS)
• Defined benefit plan that provides for life-long income upon retirement.
• Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
• Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program
• Voluntary participation.
• Program administered through Nationwide.
• Tax-deferred retirement investments through payroll deductions.

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.

Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.