Address:  150 North 18th Avenue Phoenix, Arizona 85007

Must Reside in Arizona.

Salary: $50,000 - $60,000

Grade: 21

FLSA Status Non-Exempt

This position will remain open until filled.

This position may offer the ability to work remotely, within Arizona, based upon the agency’s business needs and continual meeting of expected performance measures. 

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.

Major duties and responsibilities include but are not limited to:
• 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%)

Knowledge:
• AHCCCS Fee For Service, MCO and American Indian Health Plan policy and guidelines
• Research, communications and briefings techniques
• Government process experience related to: auditing, process improvement, Medicaid/Medicare or behavioral health, data collection/metrics, medical coding/billing and encounters, reconciling records, and program management
• Extensive knowledge of accounting principles and practices in accordance with the Generally Accepted Government Auditing Standards (GAGAS) data validation and focused audits
• Arizona Revised Statutes related to fraud, fraud schemes, various financial crimes, theft and other criminal acts as warranted
• Federal laws regarding healthcare to include the appropriate Code of Federal Regulations within Title 42, USC

Skills:
• Research, mathematics, financial reconciliation processes, data analysis, problem solving, and computer skills that include Microsoft Office
• Communicate effectively verbally and in writing
• Investigating or auditing people or businesses for Fraud, Waste or Abuse; understanding the basics for gather evidence related to Health Care fraud, waste and abuse.

Abilities:
• Analyze, interpret and communicate data, communicate effectively both verbally and in writing, conduct performance audits, understanding the process and administrative function
• Perform accurate and timely work with minimal supervision
• Interpret and explain financial, operational and administrative information, take initiative
• Work in a team environment, plan, summarize and analyze large amount of complex information and data and to present information in a clear and concise fashion into a formal reporting document
• Attend training, meetings, or other job related duties in person when requested
• Drive a State issued vehicle and maintain an Arizona Driver's License

• Arizona Driver License
Minimum:
• At least two years' experience as an Auditor, investigator or equivalent; Bachelor's Degree in Accounting, Healthcare, Criminal Justice or related field.

Preferred:
• 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.

• 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 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.