ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork
Fee For Service Audit Investigator
First Resume Review: 08/31/2020
Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid Agency, is driven by the passion to deliver comprehensive and cost effective health care to Arizonans in need. AHCCCS is nationally acclaimed as a model for other Medicaid programs and recipient of multiple awards for excellence in workplace effectiveness and flexibility.
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. Visit our careers page to learn more about AHCCCS. Use your skills to benefit others; join the AHCCCS Team!
JOB SUMMARY: The Office of Inspector General is looking for a highly motivated individual to join our team as a Fee For Service Audit Investigator. The incumbent will perform audits/investigations on Fee For Service business providers to establish if program violations have occurred Major duties and responsibilities include but are not limited to:
* Conduct internal and external audits/investigations pertaining to AHCCCS FFS, AIHP, 638/IHS, TRBHA, and FQHC business regarding provider allegations and/or to verify program of integrity in all aspects of OIG to ensure compliance and integrity (Analyze claims, encounter data, review medical records, conduct on-site visits, record interviews, produce high level reports, audit related correspondence, CMP's).
* Research Policy and procedures, statutes and changes to Medicaid/Medicare as it relates to compliance, in
* Ability to analyze and interpret data to effectively communicate the audit results
* Assist in the review and tracking of Corporate Compliance Deliverables for FFS/AIHP
* Exhibit oral and written communication skills to effectively communicate; produce high level reports and correspondence for internal and external customers; such as Executive Management, Internal AHCCCS Divisions and overpayment reports with losses to the Medicaid program for both internal purposes and external, such as; lawyers, MFCU/AG's office.
* Conduct interviews and obtain written statements from AHCCCS providers, and clients as it relates to audit/
KNOWLEDGE, SKILLS AND ABILITIES (KSAs): * Knowledge of: AHCCCS Fee For Service and American Indian Health Plan policy and guidelines. Research, communications and briefings techniques; government process experience related to: auditing, process improvement, Medicaid/Medicare or behavioral health, data collection/metrics, medical coding/billing and encounters, reconciling records, and program management.
* The auditor must have extensive knowledge of accounting principles and practices in accordance with the Generally Accepted Government Auditing Standards (GAGAS) data validation and focused audits.
* Skilled in: research, mathematics, financial reconciliation processes, data analysis, problem solving, computer skills that include MicroSoft Office, and Google Docs.
* Ability to: analyze, interpret and communicate data, communicate effectively both verbally and in writing, conduct performance audits, understanding the process and administrative function, perform accurate and timely work with minimal supervision.
* Interpret and explain financial, operational and administrative information, take initiative. Work in a team environment, plan, summarize and analyze large amount of complex information and data and to present information in a clear and concise fashion into a formal reporting document.
SELECTIVE PREFERENCE(S): * 2-3 years of work experience related to/in Analytical Background or 5 years of Audit Experience.
* 3 - 5 years of experience and understanding of the AHCCCS DFSM Division with a working knowledge of OIG process and procedures.
* Strong computer skills, understanding the importance of data collections in accordance with the Generally Accepted Government Auditing Standards (GAGAS)
BENEFITS At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan. Click here to learn more about benefits.
Arizona State Government is an EOE/ADA Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by calling (602) 417-4497. Requests should be made as early as possible to allow sufficient time to arrange the accommodation. AHCCCS is an Equal Employment Opportunity Employer. All newly hired employees will be subject to E-Verify Employment Eligibility Verification.
Click the APPLY NOW button to submit your application.
Please apply for this position by following the link provided below. A new window will open on your screen and you will be directed to the Arizona Health Care Cost Containment System (AHCCCS) employment website.