***********************QUALIFYING CANDIDATES MUST HAVE BILLING AND CODING EXPERIENCE***********************
Conducting investigations of allegations against allopathic physicians and physician assistants licensed in Arizona.
The Medical Investigator will also investigate quality of care complaints and professional conduct violations.
Matters investigated can include sensitive issues such as substance abuse and sexual misconduct. Some duties are equivalent of a paralegal, such as preparing and serving subpoenas.
Additionally, a Medical Investigator must also utilize their judgment when prioritizing, planning, organizing and conducting investigations including interpreting statutes and rules, drafting case reports, conducting site inspections and investigational interviews, and present cases before the Arizona Medical Board in addition to testifying before the Office of Administrative Hearings.
•Experience performing clinical coding reviews to ensure accuracy of medical coding and utilize expertise and judgment to determine correct coding/billing
•Computer skills with working knowledge of Microsoft products, the Internet, and database input and retrieval
•Certification as a fraud examiner, health care fraud investigator, or coder is preferred
•Excellent written and oral communication skills with attention to detail
•Knowledge of statutes and rules governing the practice of medicine
•Medical billing/coding experience is a plus
•Familiarity with medical records review
•Independent working skills (requiring minimum supervision), interviewing techniques to elicit information, effective verbal and written communication, basic computer skills, interpersonal relations as applied to contact with attorneys, physicians, and members of the pubic, the use of tactful diplomacy due to the nature of the job
•Skills in applying and interpreting Federal and State statutes and rules governing investigations and the practice of medicine
•Skills in production of timely and accurate reports and documentation
•Public speaking skills to present cases in a hearing or trial setting
•Must be able to handle and prioritize a large case load
•Skills in reading and interpreting medical records
•Ability to extract and utilize facts from a variety of sources and apply the relevant statutes, rules and policies to prepare clear, accurate and quality legal documents within specified time frames
•Must be able to function in an orderly and purposeful manner under pressure or in high stress situations and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
•Ability to conduct investigations, including review of medical records to determine relevance to the investigation
•Ability to multi-task, prioritize, plan, analyze, and coordinate investigations
•Ability to work in a team environment
The State of Arizona offers a comprehensive benefits package to include:
•Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance
•Life insurance and long-term disability insurance
•Vacation plus 10 paid holidays per year
•Health and dental insurance
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
•Positions in this classification participate in the Arizona State Retirement System (ASRS)
•Please note that enrollment eligibility will become effective after 27 weeks of employment
If you have any questions please feel free to contact Luis Bustamante at email@example.com for assistance.
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.
Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.