AHCCCS

Address: 150 North 18th Avenue Phoenix, Arizona 85007

All AHCCCS Employees must reside within the state of Arizona.

Salary: $50,000 - $55,000

FLSA Status: Exempt

Grade: 21

This position will remain open until filled.

This position will report to an Audit Supervisor in the AHCCCS Office of Inspector General (OIG). This position will be responsible for auditing and monitoring Providers and Health Plans; providing technical assistance; working interdependently and in a team environment. This individual will be working with AHCCCS Providers, Health Plans, and internal staff to obtain required documentation, process information, and generate required reports and correspondence.

Major duties and responsibilities include but are not limited to:
• Conduct On-site and Desk Audits with Providers and Contractors to ensure compliance and program integrity with AHCCCS contract and policy requirements.
• Monitor Contractor to ensure compliance and program integrity with AHCCCS contract and policy requirements. This includes reviewing contract deliverables and providing corrective action.
• Analyze and interpret data to effectively communicate auditing and monitoring results.
• Research and understand Federal and State Statutes pertaining to AHCCCS and Medicaid, AHCCCS Policies, as well as Medical coding.
• Research and understand Federal and State Statutes pertaining to AHCCCS and Medicaid, AHCCCS Policies, as well as Medical coding.
• Coordinate activities with Federal and State regulations, contracts, policies, and guidelines to ensure compliance.
• Provide guidance and technical assistance to internal and external customers at various levels.
• Produce high level reports and correspondence for internal and external customers.
• Assist in the development of internal and external auditing and monitoring processes.

Knowledge:
• Research, government process experience related to auditing, process improvement
• AHCCCS, Medicaid, behavioral health, healthcare
• Data collection, metrics, medical coding/ billing and encounters, reconciling records
• Understanding of AHCCS Health Plans and the role they play in Arizona’s Medicaid System
• 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

Skills:
• Research, data analysis, problem solving
• Computer skills that include Microsoft Office including Outlook and Excel,
• Written and verbal communication to include report writing and speaking to various levels of leadership.
• Applying contract and policy language to documents being reviewed composed
• Take initiative in order to complete tasks in a timely manner
• Conflict resolution

Abilities:
• Analyze, interpret and communicate data, and analyze large amounts of complex information and data
• Conduct multiple auditing and monitoring tasks, accurately and timely with minimal supervision
• Work in a team environment or independently
• Present information in a clear and concise fashion into formal reporting documents
• Interpret and apply Federal and State Statutes and Agency policies
• Conduct audits, manage time effectively, deal with difficult situations in a calm manor
• Conduct interviews in person or telephonic and write information gained in clear and concise manner
• Drive a State vehicle; conduct field work to support an audit when necessary
• Function in a virtual office environment

Arizona Driver's License.

Minimum:
• Two to three years experience working in a Managed Care Organization (MCO).

Preferred:
• BA in a Health Care related field and/or 2-3 years of work experience related in an Analytics, Auditing, Health Care, or Medical Coding. Strong computer skills, understanding the importance of data collections in accordance with the Generally Accepted Government Auditing Standards (GAGAS)

• 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.) 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.  

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 pilot 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.