Title: Provider Compliance Coordinator
Provider Compliance Coordinator
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.
Provider Compliance Coordinator
Office of Inspector General (OIG)
Address: 801 E. Jefferson Street, Phoenix, AZ 85034
Salary: $47,000 - $57,000
Position will remain open until filled
The incumbent in this position is a liaison between OIG, Law Enforcement entities, Other State Agencies, Health Plans, Internal AHCCCS divisions and the public. The incumbent will work closely with the Inspector General and Deputy Assistant Director providing updates on investigations, composing and sending correspondence to providers, requesting recoupment of overpayment and settlement monies. They are also responsible for processing and tracking all Provider Self Disclosures.
Major duties and responsibilities include but are not limited to:
* Receives, review and analyzes information obtained from Provider Compliance Unit (PCU) referrals; assess the allegations of referrals and determines its outcome, closing or assigning cases. Obtains information from collateral sources such as other AHCCCS divisions, State Attorney General's office and other state agencies, law enforcement, providers, law firms, members, etc., to verify allegations.
* Coordinate and track case coordination efforts with law enforcement, Attorney's General, FBI, DEA, Court Progression including case outcomes and judgments. Complete all Self Disclosure cases and collect financial findings and report to DBF Finance and DGA Grants Administration all Findings and documentation.
* Prepares and maintains several tracking logs and reports that are crucial to several OIG State and Federal reporting and audits. Tracks and reports on various financial matters for the Inspector General. Enters cases into tracking system and assigns to investigators.
* Analyzes data collected, composes written reports of investigative summaries, and reports preliminary findings to Provider Compliance Deputy Assistant Director for case assignment. Plans, schedules, prioritizes work activity; sets up workload controls, determines priorities, and monitors activity progress.
* Communicates with health plans regarding referrals and other compliance matters. Provide information and training when necessary.
* Organizes the quarterly CONG meeting conducted by ZOOM attended by the health plans' corporate compliance officers and their staff. Maintains current and up-to-date staff list for invite list to ensure full compliance of attendees. Coordinate CEU credits for all attendees with AAPC coordinator.
* Obtains, tracks and maintains police reports for the entire agency.
* Claims reporting activity
* Microsoft Windows software, Excel spreadsheet software, and basic understanding of data base software
* Medicaid Programs and Prepaid Medical Management Information System (PMMIS) and/or DES Eligibility System (AZTECS)
* Expert knowledge of State statute, rules and regulation relating to the determination of eligibility for AHCCCS programs, Legal and technical terminology for the interpretation of highly diverse forms of verification including, but not limited to, divorce decrees, county property assessment records, medical records, hospital billings, life insurance policies, public assistance benefits and self-employment records
* Analyzing case records
* Evaluation and interpretation of written and verbal information
* Troubleshooting and problem solving skills
* Research methodologies
* Independent working skills (requiring a minimum of supervision)
* Interviewing techniques to elicit information
* Effective verbal and written communication
* Basic computer skills
* Interpersonal relations as applied to contact with public and private organization representatives
* Use of tactful diplomacy due to the political nature of the job
* Provide effective guidance and expertise in the development and implementation of programs and projects in the OIG
* Review and evaluate activities analytically and to develop effective plans and methods for process improvement
* Establish and maintain effective working relationships
* Work within a team environment
* Function effectively in an orderly and purposeful manner in situations of stress or tension
* Work with the public in less than ideal conditions, deal with multiple tasks at one time
* Successfully work and be productive in a virtual environment
AZ Driver's License.
* 3+ years of progressive program experience working with Medicaid or Healthcare Programs or similar work.
* Knowledge of Proper methods of interviewing suspects, witnesses and victims, and of the rules regarding the admissibility of statements, admissions and confessions.
* Additional knowledge of Title 19, Non Title 19, and ASRS title 13 & 36 a plus.
* 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 email@example.com.
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.