Auditor 3
Auditor 3
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Job Description
AHCCCS
Arizona Health Care Cost Containment System
Accountability Community Innovation Leadership Passion Quality Respect Courage Teamwork
The Arizona Health Care Cost Containment System (AHCCCS) Arizonas Medicaid agency is driven by its mission to deliver comprehensive costeffective 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 entrylevel positions and internship opportunities AHCCCS offers meaningful career opportunities in a competitive industry.
Come join our dynamic and dedicated team.
Auditor 3
Office of Inspector General (OIG)
Address:801 E. Jefferson Street Phoenix AZ 85034
All AHCCCS Employees must reside within the state of Arizona.
Salary: $50000 $57000
Grade: 21
Position will remain open until filled.
This position is directly involved in negotiating the final determination of financial over payments and recommending civil monetary penalties levied against providers participating in fraudulent billing practices. The information obtained by this position is used for a variety of activities such as: determination of fines restitution and cost avoidance; internal deliberations regarding settlement amounts for fines and restitution participate in the decisions regarding opening and closing of criminal and civil investigations.
Major duties and responsibilities include but are not limited to:
Complete required health care fraud audits to establish if program violations have occurred through billing health care records financial documentation access to mainframe computer systems at AHCCCS DES MVD and DPS.
Develop and prepare complex spreadsheets and flowcharts indicating under payments misuse of funding and billings obtained through the audit process.
Develop overpayments: losses to the Medicaid Program through diligent research and review in order to present the evidence to the legal authorities for prosecution
Communicate effectively with the providers and contractors occasionally under adverse arid threatening circumstances. Authority to draft and serve subpoenas and take sworn statements
Conduct interviews and obtain written statements from providers and clients to determine if fraudulent activities have occurred.
Prepare written reports for use in administrative or legal proceedings
Knowledge:
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
Claims processing procedures financing and operations for FFS and MCO
Preparation of computerized spreadsheets which support audit findings
Income and resource requirements for eligibility for each of these varied programs Arizona Revised Statutes State Personnel Rules.
Skills:
Legal decisions as they relate to the admissibility of evidence confessions admissions and statements
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 operation 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 conflict resolution.
Abilities:
Interpreting and applying Federal and State Statutes and Agency policies
Conduct investigations Manage time effectively deal with difficult situations in a calm manor
Effectively handle hostile situations.
Drive a State vehicle.
Function in a virtual office environment.
Drivers License.
Minimum:
Bachelors Degree in accounting or closely related field or at least two years experience as an Auditor or equivalent.
Preferred:
Certified Professional Coder (CPC) Certified Fraud Examiner Certification (CFE) and/or eligibility experience. Knowledge of Title 19 ASRS 13 and 36 (is preferred but not required)
Successfully pass fingerprint background check prior employment verifications and reference checks; employment is contingent upon completion of the abovementioned process and the agencys 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 R210207.12.
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:Drivers License Requirements.
All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (EVerify).
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 parttime employees)
Paid Parental LeaveUp to 12 weeks per year paid leave for newborn or newlyplaced foster/adopted child. Learn more about the Paid Parental Leave pilot program here.
Other Leaves Bereavement civic duty and military.
A topranked 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 fulltime or parttime 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 programhere. 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 lifelong income upon retirement.
Required participation for LongTerm Disability (LTD) and ASRS Retirement plan.
Pretaxed payroll contributions begin after a 27week waiting period (prior contributions may waive the waiting period).
Deferred Retirement Compensation Program
Voluntary participation.
Program administered through Nationwide.
Taxdeferred 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 .
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.
Employment Type
Full-Time
