AHCCCS

Address: DBF - Division of Business and Finance (DBF)
150 N. 18th Ave., Phoenix, Az 85007

Must Reside in Arizona.

Salary:  $42,460.08

Grade: 19

FLSA Status: Non-Exempt

Closing Date: 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.

The Division of Business and Finance (DBF) is looking for a highly motivated individual to join our team as an Auditor 2. This position helps coordinate all areas of the AHCCCS Reinsurance Program as related to the contractual agreement with the AHCCCS Managed Care Organizations (MCOs) and Program Contractors, and reimbursement for transplant related services for nine Indian Health Services (IHS) Fee for Service plans. This staff member will determine compliance with contractual agreements for Reinsurance consideration for acute, catastrophic and transplants.

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:
• Audit PMMIS encounters and reinsurance payments to ensure that they are appropriately encountered by the contractor and processed. Use knowledge of coding and claims as well as AHCCCS Reinsurance processing rules to assist the Contractor, when necessary, in identifying impediments to processing though PMMIS.
• Audit critical monthly reports to ensure contractors program compliance and make necessary recommendations when needed.
• Audit, Research and Adjudicate Reinsurance claims based on interpretation of AHCCCS Policies, Procedures and Contracts and laws.
• Audit and Process Catastrophic & Transplant Reinsurance cases for adjudication and payment.
• Communicate with internal and external personnel on a daily basis including by phone or email. Provide technical system/training support to external and internal users including assisting with annual training conducted by the reinsurance team.
• Develop and analyze a variety of data warehouse reports and Excel workbooks for paid adjudicated encounters and reinsurance payments to ensure that encounters are properly submitted by the contractor and processed so that they will be included in the data used by actuaries when developing managed care capitation rates.
• Provide technical system/training support to external and internal users. assist with Technical Assistance to MCOs and participate in the annual Contractor Workshop.
• Recommend system changes/enhancements to comply with contracts.

Knowledge of:
• AHCCCS Reinsurance Policy and Procedures
• AHCCCS Contracts for MCOs, Program Contractors and Fee for Service
• Knowledge of principles and practices of auditing and accounting
• Demonstrated experience with claims, encounters or ICD-9 or 10 coding
• Policies and Procedures established for the work system
• Prepaid Medical Management Information System (PMMIS) Reinsurance sub-system
• AHCCCS Encounter processing
• Health Insurance Portability and Accountability Act (HIPAA) requirements as related to the AHCCCS Reinsurance Program
• Coding as related to Current Procedural Terminology (CPT), Health Care Financing Administration Common Coding System (HCPCS), International Classification of Diseases (ICD-10)
• Working knowledge of Microsoft Office and Other Software: Cognos, Excel, Google Docs/Sheets and Google Mail
• Techniques of complex research

Skill in:
• Techniques of complex research
• Demonstrated skills in auditing
• Strong customer service skills
• Excellent interpersonal, written, oral communication
• Demonstrated experience working in the PMMIS system
• Applying and interpreting federal and state laws, rules and policies as they pertain to program operations and activities
• Applying claims auditing methods and techniques

Ability to:
• Demonstrated ability to balance, prioritize and organize multiple tasks, work collaboratively in teams
• Work under limited supervision
• Prioritize projects

Minimum:
• Experience in auditing work, principles, standards and technique.

Preferred:
• Bachelor's degree in accounting or closely related field.

• 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.