Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork
Healthcare Claims Auditing Manager
OPEN TO AHCCCS EMPLOYEES ONLY
Apply by: 07/18/2019
This position will remain open until filled
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!
The Division of Fee for Service Management (DFSM) is looking for a highly motivated individual to join our team as Healthcare Claims Auditing Manager. Responsible for the oversight of 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:
* Overseeing sample audits, reviewing provider records checking compliance with federal and state rules, regulations, and AHCCCS policies and procedures, and identifying recoupment amounts.
* Oversight of Audit Staff
* Reviews and analyzes regulations and laws applicable to the AHCCCS program.
* Develops procedures and methods for enhancement of the program’s records submission process.
* Provides back-up assistance with the grievance and hearings assigned to the Claims Claims Policy
* Participates in the Division of Fee For Service Management (DFSM) Leadership Operations and ensures audit area is up to date.
KNOWLEDGE, SKILLS AND ABILITIES (KSAs):
* Knowledge of the principles and practices of supervision and staff development.
* Knowledge of the principles and practices of auditing.
* Skills of interpreting rules and regulation, policies and procedure as it relates to the program
* Skill to analyze and effective recommend resolutions to the provider issues.
* The ability to work independently with minimal direction
* The ability to apply auditing methods and techniques.
* Knowledge of AHCCCS Information Management System Prepaid Medical Management Information System (PMMIS)
* Knowledge of AHCCCS, ALTCS Medicaid and Medicare Regulations.
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.
For technical assistance, email HRIShelpdesk@azdoa.gov or call 602-542-4700.