Title: Member Compliance Investigator
Member Compliance Investigator
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.
Member Compliance Investigator (Auditor 3)
Office of Inspector General (OIG)
Address: 801 E. Jefferson St., Phoenix, Arizona 85034
Salary: $47,300 - $57,200
Open until filled: First review of resumes on 11/01/2023
The Office of Inspector General is looking for a highly motivated individual to join our team as a Member Compliance Investigator, This position conducts complex criminal and civil investigations relating to allegations of Medicaid eligibility fraud. In depth research investigative report writing, researching Medicaid eligibility rules, policies, statutes. Prepare documentation for Civil and Criminal Prosecution.
Major duties and responsibilities include but are not limited to:
* Conducts in depth investigations that include field investigations, surveillance, interviewing and interrogating subjects or witnesses in their home or agency's office.
* Compiles, analyzes, organizes, Medicaid eligibility records, financial records and other related documents; Composes detailed reports of investigations to submit to prosecuting agencies for criminal prosecution and/or administrative action.
* Conducts investigative Internet searches, uses and interprets other investigative sources such as : ACJIS, Experian Credit Reports, CLEAR, Lexis Nexis, Vital Records, AZ Corp Commission, NWSC, AZ MVD reports, Etc.
* Collects, Examines, and preserves information, documents and records for evidence.
* Interprets applicable, federal and state laws, agency rules, regulations and policy regarding Medicaid eligibility and criminal violations.
* Serves Subpoena's to obtain necessary evidence to prove or disprove allegations of Medicaid fraud.
* Participates in special projects that may include out of town travel involving residency/eligibility checks of participants as well as on-site audits of certain high risk Medicaid providers. Must be willing to travel overnight if necessary.
* Criminal, civil and administrative law, Federal Medicaid/Medicare statutes, rules and regulations as they relate to Title 19, 16, & 21 United States Code
* Arizona Revised Statutes, titles 13 and 36, Computerized AHCCCS and the Arizona Department of Economic Security (DES) mainframe systems to effectively extract relevant information List Knowledge areas from PD here
* Various types of eligibility programs including but not limited to; Social Security Disability, Long Term Care program, Supplemental Security Income, Temporary Assistance to Needy Families (TANF) program, and the Sixth Omnibus Budget Reconciliation Act (SOBRA)
* Income and resource requirements for eligibility for each of these varied programs
* Preparation of detailed computerized spreadsheets to show how the fraud and accompanying loss of funds to the program was perpetrated, State Personnel Rules when state employees may be the subject of an investigation
* AHCCCS divisions, the services they provide and how they interact with other divisions
* Principles of accounting practices and audit techniques
* Legal decisions as they relate to the admissibility of evidence, confessions, admissions and statements
* Proper methods of interviewing suspects, witnesses and victims, and of the rules regarding the admissibility of statements, admissions and confessions
* Effective methods to conduct a covert operation to identify fraudulent activity
* Investigative methods, techniques, and approaches, necessary to plan and conduct criminal, civil and administrative investigations relating to the operations and activities of AHCCCS, conflict resolution
* Interpreting and applying Federal and State Statutes and Agency policies
* Conduct investigations, Manage time effectively, deal with difficult situations in a calm manor
* Effectively handle hostile situations
* Drive a State vehicle
* Successfully function in a virtual office environment
* At least two years' experience as an Auditor or equivalent OR; Bachelor’s Degree in Accounting, Healthcare, Criminal Justice or related field.
* CPC, CFE Certification, or Medical or Health Care financial background, or 4 yrs of eligibility experience, or a 4 year degree from accredited university in a closely related field.
* Knowledge of proper methods of interviewing suspects, witnesses and victims, and of the rules regarding the admissibility of statements, admissions and confessions, and Title 19, ASRS 13 and 36.
* 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 is 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.
If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements.
All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).
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)
* Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
* Other Leaves - Bereavement, civic duty, and military.
* 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
By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.
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 firstname.lastname@example.org.
Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.