Job Description

PHOENIX 33,500.00-38,000.00

Arizona Health Care Cost Containment System

Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork

Healthcare Claims Auditor


Apply By: 02/17/2020

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 a Healthcare Claims Auditor. This position will be responsible for a variety of claim audits including, but not limited to, Adult Dental, Behavioral Health, Global OB, Inpatient, Outpatient Clinical, Non-emergency transportation, Podiatry, etc. Major duties and responsibilities include but are not limited to:

* Conducts sample audits, reviewing provider records, checking compliance with federal and state rules, regulations, and AHCCCS policies and procedures, and identifying recoupment amounts.

* Review and analyze regulations and laws applicable to the AHCCCS Program. Assist 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 resolution of issues.

* Coordinates with others in DFSM for feedback, to ensure continual improvement of the policy audit education processes.


* Thorough knowledge of all aspects of claims processing.

* Knowledge of the principles and practices of auditing.

* Skilled in interpreting rules and regulations, policies and procedures as it relates to the program.

* Skilled in mathematical computation.

* Possess intermediate computer skills.

* Excellent oral and written communication skills.

* Detailed oriented.


* Previous experience as a healthcare claims auditor.

* Knowledge of the AHCCCS program.

* Willing to work Virtual Office.


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 or call 602-542-4700.

Application Instructions

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.

Apply Online