Program Compliance Auditor 3
Program Compliance 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.
Program Compliance 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: $49500 $53840
Grade: 21
Position will remain open until filled.
This position conducts complex criminal and civil investigations relating to allegations of Medicaid eligibility fraud. In depth research investigative report writing researching Medicaid eligibility rules policies statutes. Prepare documentation for Civil and Criminal Prosecution.
Major duties and responsibilities include but are not limited to:
Conducts in depth investigations that include field investigations surveillance interviewing and interrogating subjects or witnesses in their home or agencys office.
Compiles analyzes organizes Medicaid eligibility records financial records and other related documents; Composes detailed reports of investigations to submit to prosecuting agencies for criminal prosecution and/or administrative action.
Conducts investigative Internet searches uses and interprets other investigative sources such as : ACJIS Experian Credit Reports CLEAR Lexis Nexis Vital Records AZ Corp Commission NWSC AZ MVD reports Etc.
Collects Examines and preserves information documents and records for evidence
Interprets applicable federal and state laws agency rules regulations and policy regarding Medicaid eligibility and criminal violations
Serves Subpoenas to obtain necessary evidence to prove or disprove allegations of Medicaid fraud
Participates in special projects that may include out of town travel involving residency/eligibility checks of participants as well as onsite audits of certain high risk Medicaid providers. Must be willing to travel overnight if necessary.
Other duties as assigned as related to the position (typically 5 10
Knowledge:
Criminal civil and administrative law Federal Medicaid/Medicare statutes rules and regulations as they relate to Title 19 16 & 21 United States Code
Arizona Revised Statutes titles 13 and 36 Computerized AHCCCS and the 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)
Income and resource requirements for eligibility for each of these varied programs
Preparation of detailed computerized spreadsheets to show how the fraud and accompanying loss of funds to the program was perpetrated State Personnel Rules when state employees may be the subject of an investigation
AHCCCS divisions the services they provide and how they interact with other divisions
Principles of accounting practices and audit techniques
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
Successfully function in a virtual office environment
Minimum:
At least two years experience as an Auditor or equivalent or Bachelors 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 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 programhere.
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.
For a complete list of benefits provided by The State of Arizona please visit ourbenefits 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
