AHCCCS

Address: 150 North 18th Avenue Phoenix, Arizona 85007

All AHCCCS Employees must reside within the state of Arizona.

Salary: $100,000 - $110,000

Grade: 25

FLSA Status: Exempt

This position will remain open until filled.

This is a high level position that reports directly to the AHCCCS OIG Deputy Assistant Director in the Fraud Support and Recovery Section. The position will act as a liaison between AHCCCS OIG, the Unified Program Integrity Contractor (UPIC), the Recovery Audit Contractor (RAC), Centers for Medicare & Medicaid (CMS) audits, and the Arizona Attorney General's Office. This position will manage the work of the UPIC and the RAC with AHCCCS OIG, and act as the contact for AHCCCS OIG CMS audits. This position will also manage AHCCCS OIG performance and production metrics for the Inspector General. Additionally, the incumbent will supervise the OIG Collection team and manage the AHCCCS OIG collection process.

Major duties and responsibilities include but are not limited to:
• Coordinate the UPIC activity and ensure the contractor is performing as required. Communicate the performance, issues, or concerns with the UPIC to the Inspector General and Deputy Assistant Director in the Fraud Recovery and Support section.
• Coordinate the RAC activity and ensure the contractor is performing as required. Communicate the performance, issues, or concerns with the RAC to the Inspector General and Deputy Assistant Director in the Fraud Recovery and Support section.
• Manage the OIG collection process and supervise the OIG Collections team. Oversee over-payments and recoupments returned to AHCCCS OIG. Ensure the collection process is followed to accurately reflect payments received and deposited by the AHCCCS Division of Business & Finance (DBF). Determine OIG bad debt quarterly and submit bad debt write off requests to the Attorney General's office annually. Monitor balance due cases assigned to the Collection team. Assist with External audit requests.
• Generate the AHCCCS OIG monthly metrics report and charts to illustrate the performance of the OIG and OIG staff. Use OIG case management data to highlight division activity on a monthly, annual, and ad-hoc basis. Create charts to visualize the data for the Inspector General, OIG managers, supervisors, and staff. Work with all OIG staff, including Lean Champions, to recommend areas of improvement and highlight successes. Coordinate CMS audits and requests for information as the AHCCCS OIG contact. Keep the Inspector General informed on CMS audit activities.
• Coordinate CMS audits and Metric requests for information as the AHCCCS OIG contact. Keep the Inspector General and OIG leadership informed of incoming, pending, and finalized CMS requests. Manage the gathering of information required to address CMS requests.
• Assist the AHCCCS OIG Deputy Assistant Director and Audit supervisor in the Fraud Support and Recovery section with AHCCCS policy and contract revisions and development, to include contract deliverable reviews.
• Assist OIG Project Managers with projects and information as needed.

Knowledge:
• Federal and state laws rules and regulations as it pertains to State Medicaid and collection of state funds, pending and reporting
• Claims processing, procedures, financing and operations for FFS and MCO
• Auditing methods and systems of generally accepted auditing standards, risk assessments, contract and fiscal management
• Thorough knowledge of HIPAA and the rules pertaining to the sharing of investigative information
• Experience with health care compliance and/or auditing medical billing and coding
• Principles of strategic planning, performance management
• Arizona Revised Statutes

Skills:
• Mathematical and computation skills, facilitation
• Developing reports to highlight key metrics and trends
• Research methodologies, statistical sampling and quality assurance
• Creating data visualization tools to help users understand complex data
• Investigative methods, techniques, and approaches, necessary to plan and conduct criminal, civil and administrative investigations relating to the operations and activities of AHCCCS
• Extensive financial reporting responsibilities, including, but not limited to weekly/monthly reconciliation, aged balance tracking, bad debt exposure, forecasting, ad-hoc reporting as needed

Abilities:
• Work effectively with external auditors, such as Office of the Attorney's General, Auditor General, Accounting, Procurement, United Stated Attorney's Office, United States Marshall Services, CMS, and other Law Enforcement entities
• Collect, analyze, and interpret data from multiple sources
• Communicate effectively at all levels both written and orally
• Work and be productive in a virtual office setting
• Work with a wide variety of stakeholders
• Interpret and apply Federal and State Statutes and Agency policies
• Design/develop and maintain updates to user procedures, job aids, and other supporting training documentation

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.