The Division of Fee for Service Management (DFSM) is looking for a highly motivated individual to join our team as an Auditor II. Under the direction of the Claims Compliance Manager, this position will be responsible for a variety of audit types including, but not limited to, Adult Dental, Behavioral Health, Global OB, Inpatient/Outpatient Clinic, Non-emergency transportation, Podiatry, etc. Major duties and responsibilities include but are not limited to:
• Conducts sample audits, reviews provider records, checks compliance with federal and state rules, regulations, and AHCCCS policies and procedures, identifying recoupment amount and ensure accurate billing by the provider and accurate payment by AHCCCS. Review provider records and compare accuracy of information contained in AHCCCS claims adjudication system PMMIS.
• Reviews and analyzes regulations and laws applicable to the AHCCCS program. Assists in the development of procedures and methods for enhancement of the program’s records submission process. Assists with policy development.
• Develops reporting mechanism to ensure that management is constantly aware of trends or process issues. Produce reports and recommendations on resolutions of issues
• Coordinate with other units within DFSM under the direction of the Compliance Manager to support continual improvement of policy, audit, and provider training processes.
• Complete special projects.
• Knowledge of management and procedures analysis techniques and principles.
• Knowledge of principles and practices of auditing.
• Knowledge of Federal and State laws, rules, and regulations as it pertains to AHCCCS covered services.
• Oral and written communication skills.
• Skills in analyzing issues that arise during auditing and make recommendations for resolutions.
• Ability to develop procedures, analyze problems and design effective plans for programs.
• Ability to apply interpret federal and state laws, rules, and regulations as they pertain to program operations and activities.
• Experience in auditing work, principles, standards and technique.
• Previous experience as an auditor.
• Knowledge of the AHCCCS programs.
• Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
• 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 is required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.
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 (12 and 13 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
• 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
• Opportunity to work 100% virtually or remotely on an ad-hoc basis (home office)
By providing the option of a full-time or part-time virtual/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 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 email@example.com.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.
ARIZONA MANAGEMENT SYSTEM (AMS)
All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress. Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results.
State employees are highly engaged, collaborative and embrace a culture of public service.
The State of Arizona is an Equal Employment Opportunity Employer.