• 515380

• PHOENIX
• REMOTE OPTIONS

• AHCCCS

• Full-time

AHCCCS

Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.

AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.

Come join our dynamic and dedicated team.

Address:  801 E. Jefferson Street, Phoenix, AZ 85034

Apply by February 20, 2023

Salary: $47,300 - $57,200 

Grade: 21

This position may offer the ability to work remotely within Arizona based upon the department's needs and continual meeting of expected performance measures.  

The Office of Inspector General is looking for a highly motivated individual to join our team as a Medical Coding Auditor . The purpose of this position is to uphold the integrity of the Medicaid program through data analysis, ad hoc claim/encounter reports, case evaluations, audits, investigations, and an assortment of program integrity projects. The reports and evaluations are used for a variety of purposes including decisions regarding the opening and closing of criminal and civil investigations, and determination of fines, restitution, and cost avoidance. The employee is also responsible for recommending and interpreting Medicaid policies, CPT coding, MCO and provider contract language, and Arizona State Statutes and Administrative Codes that pertain to Medicaid fraud, waste and abuse.

Major duties and responsibilities include but are not limited to:

• Perform detailed research and data analysis of encounter and claims information gathered from referrals, data mining, the AHCCCS mainframe and Lexis Nexis. Maintain thorough and detailed case notes for each investigation. Respond to intelligence information requests that include case evaluations, ad-hoc reports, data samplings and inter-agency requests for information. Perform investigations and participates in Program Integrity audits as assigned. 
• In the course of investigations and audits, perform medical record reviews, CPT coding analysis, and handle provider appeals, and health plan issues related to audit recoveries. Conduct ancillary investigations as well as investigations as required based on the needs of the Program Integrity Team.
• Based on data analytics, prepare complex spreadsheets and graphs indicating over payments, misuse of funding and aberrant billings identified through investigations, the audit process, and data analytic activities. Maintain and update shared team spreadsheets accurately. 
• Identify the civil and/or criminal components of a case, and when appropriate present the criminal evidence to law enforcement for prosecution. Follow rules of evidence in maintaining documents, retention, and disposition. 
• Coordinate with various AHCCCS divisions, AHCCCS providers, health plans, other state agencies, and licensing boards to uphold the integrity of the Medicaid program.
• Conduct informational meetings, interviews and obtain statements from AHCCCS providers to determine if fraudulent activities have occurred. Draft and serve subpoenas and take sworn statements. Prepare written reports for use in administrative or legal proceedings. 
• Attend meetings, participate in discussion topics, and prepare and present program integrity material for process improvement.

Knowledge of:

• Claims and Encounters, HIPAA, CPT Coding, Medical Terminology, Microsoft Office (especially Excel), AZ revised Statutes, Medicaid and Medicare fraud, waste and abuse statutes, and Investigative techniques.

Skilled in:

• Data analytics, Investigative methods, Program compliance auditing, Preparation of detailed spreadsheets, Medical record analysis, Problem solving, Application of appropriate laws, regulation, and policies, Written and verbal communications, Research analysis, and Time management.

Ability to:

• Analyze healthcare data for fraud, waste and abuse, Prepare reports in a clear and concise manner, Drive a state vehicle, Conduct a logical investigation as necessary, Work independently as well as part of a team, Successfully function in a virtual office environment.

Minimum:

• Bachelor’s Degree in accounting or closely related field or at least two years' experience as an Auditor or equivalent. 

Preferred:

• Certified Professional Coder (CPC), Certified Fraud Examiner Certification (CFE), and/or eligibility experience. Knowledge of Title 19, ASRS 13 and 36 (is preferred but not required)

* Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
* 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.

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)
* 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

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. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.