Data Analytic Investigator

2 months ago


Phoenix, United States Arizona Official Website of State of Arizona Full time

Job Summary:

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 data mining, the AHCCCS mainframe and OIG analytical systems. Maintain thorough and detailed case notes for each investigation. Respond to intelligence information requests that include case evaluations, self-audits, ad-hoc reports, random sample requests, global data requests, pharmacy reports, data samplings, audits and inter-agency requests for information.
• Perform medical record reviews, CPT coding analysis, and handle provider appeals and health plan issues related to audit recoveries; Identify AHCCCS policies, state and federal regulations pertinent to audits and investigations performed by PIT, and conduct ancillary investigations as well as investigations as required based on the needs of the Program Integrity Team.
• Develop and prepare complex spreadsheets and graphs indicating over payments, misuse of funding and aberrant billings identified through 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 interviews and obtain written statements from AHCCCS providers to determine if fraudulent activities have occurred. Authority to 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, Skills & Abilities (KSAs):

Knowledge:
• Claims and encounter processing
• HIPAA
• CPT coding
• Medical records
• Microsoft Office (especially Excel)
• Arizona revised statutes
• Medicaid and Medicare fraud, waste and abuse statutes
• Investigative techniques

Skills:
• Data analytics
• Investigative methods
• Program compliance auditing
• Preparation of detailed spreadsheets
• Medical record analysis
• Problem solving
• Application of appropriate laws, regulations and policies
• Written and verbal communication
• Research analysis
• Team oriented

Abilities:
• 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

Qualifications:

Minimum:
• At least two years' experience as an Auditor or equivalent or Bachelor’s Degree in Accounting, Healthcare, Criminal Justice or related field.

Preferred:
• 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.

Pre-Employment Requirements:

• 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 .) 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: 

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

Benefits:

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.

Learn more about the Paid Parental Leave pilot program . For a complete list of benefits provided by The State of Arizona, please visit our

Retirement:

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.



  • Phoenix, United States Shamrock Foods Company Full time

    Provide enterprise managed, certified datasets that are prepared and modeled to to empower end-users to create their own business intelligence & analyticsEssential Duties: Develop effective business intelligence strategies and analytics solutions to solve complex business problems and facilitate data-driven decision makingApply software engineering and...


  • Phoenix, United States TekStaff Solutions Full time

    Job Title: Data Analytics ArchitectLocation: Phoenix, AZ. Must be able/willing to go onsite 2-4 days per week.Position Type: contract to possible hireAbout the Role:We are seeking an experienced Data Analytics Architect with advanced expertise in Snowflake, Kafka, Flink, Aurora, and Snowpark. The ideal candidate will be responsible for driving the enterprise...


  • Phoenix, United States TekStaff Solutions Full time

    Job Title: Data Analytics ArchitectLocation: Phoenix, AZ. Must be able/willing to go onsite 2-4 days per week.Position Type: contract to possible hireAbout the Role:We are seeking an experienced Data Analytics Architect with advanced expertise in Snowflake, Kafka, Flink, Aurora, and Snowpark. The ideal candidate will be responsible for driving the enterprise...


  • Phoenix, United States Bank of America Full time

    Description : This job is responsible for performing end-to-end investigations or investigations support functions of external financial crimes activities across one or more lines of business. Key responsibilities include conducting routine to complex investigations, including fraud committed by external parties, money laundering, or terrorist...

  • Data Analyst

    1 month ago


    Phoenix, United States Sol Technology Partners Full time

    This is a direct hire full-time position with a hybrid work model, requiring in-person attendance once a quarter (highly preferred for in-state candidates).The ideal candidate will have 3-5 years of experience in healthcare data analysis, a BS degree or higher, and proficiency in SAS, SQL, and Python.The role involves supporting value-based care (VBC)...

  • Senior Data Scientist

    11 hours ago


    Phoenix, Arizona, United States Vaco Full time

    About the RoleVaco is seeking a highly skilled Senior Data Scientist to join our team in the education sector. As a key member of our data science team, you will be responsible for developing and deploying machine learning models in AWS using Python and R. Your expertise will be crucial in driving business growth through data-driven insights and strategic...


  • Phoenix, United States Upgrade, Inc. Full time

    About the Role: Upgrade is searching for a Fraud Investigations Analyst to assist in reviewing incoming Identity theft claims, account take over claims, and evaluating consumer relationships for potential risk. The is an onsite position from our Phoenix office, Monday - Friday from 8:00am - 5:00pm. What You’ll Do: Conduct thorough investigations on...


  • Phoenix, Arizona, United States Upgrade, Inc. Full time

    Upgrade is searching for a to assist in reviewing incoming Identity theft claims, account take over claims, and evaluating consumer relationships for potential risk. The is an onsite position from our Phoenix office, Monday - Friday from 8:00am - 5:00pm.Conduct thorough investigations on customer's claims of fraud by utilizing internal data and open-source...


  • Phoenix, United States META Full time

    Summary: As a highly collaborative organization, our data engineers work cross-functionally with software engineering, data science, and product management to optimize growth, strategy, and experience for our 3 billion plus users, as well as our internal employee community. In this role, you will see a direct correlation between your work, company growth,...


  • Phoenix, Arizona, United States Upgrade, Inc. Full time

    About Upgrade, Inc.:Upgrade is a leading fintech organization dedicated to providing accessible and responsible financial solutions, including credit, mobile banking, and payment services to consumers. Recognized as one of the fastest-growing companies in the Americas, we have successfully delivered over $31 billion in responsible credit to our 5 million...


  • Phoenix, Arizona, United States State of Arizona Full time

    Job SummaryThe State of Arizona is seeking a highly skilled Quality Assurance Investigative Nurse to join our team. As a key member of our Quality Management Unit, you will play a critical role in ensuring the highest level of quality care for our clients.Key ResponsibilitiesAssist with data analytics to identify trends and areas for improvement in our...

  • Data Analytics Intern

    3 months ago


    Phoenix, United States Work Visa USA Jobs (move2usajobs.com LLC) Full time

    Job DescriptionDescription: Venture into the rapidly evolving field of data analytics with our J-1 Governmental Sponsor Program, offering unique internship placements across the United States for emerging data enthusiasts. As a Data Analytics Intern, you'll immerse yourself in the analysis, interpretation, and visualization of data to drive decision-making...


  • Phoenix, Arizona, United States State of Arizona Full time

    Job SummaryThe State of Arizona is seeking a highly skilled Quality Assurance Investigative Nurse to join our team. As a key member of our Quality Management Unit, you will play a critical role in ensuring the highest level of quality care for our clients.Key ResponsibilitiesAssist with data analytics to identify trends and areas for improvement in our...


  • Phoenix, United States Upgrade, Inc. Full time

    Upgrade is a fintech company that provides affordable and responsible credit, mobile banking, and payment products to everyday consumers. We were the fastest growing company in the Americas last year according to the Financial Times and Upgrade Card was the fastest growing credit card in America two years in a row. We have delivered over $25 billion in...


  • Phoenix, Arizona, United States FM Industries Full time

    The Senior Analytical Laboratory Specialist plays a crucial role in overseeing all laboratory analytical processes, which encompass chemical, mechanical, thermo-mechanical, and microscopic evaluations and reporting. This position is primarily focused on the formulation of analytical testing protocols, as well as the operation and management of sophisticated...

  • Principal Investigator

    3 months ago


    Phoenix, United States Aztec Engineering Group Full time

    Job DescriptionJob DescriptionAZTEC is currently seeking qualified Principal Investigators to join our Phoenix, Arizona Cultural Resources Group. Job Description The purpose of this role is to develop and manage archaeological projects of all sizes from start to completion. It also involves managing staff; participating in fieldwork; preparing work plans,...


  • Phoenix, Arizona, United States DataVisor Full time

    Company Overview:DataVisor stands at the forefront of AI-driven Fraud and Risk Management solutions, providing unparalleled detection capabilities in the market. Our open SaaS platform allows for seamless integration and enhancement of diverse data, enabling organizations to respond swiftly to evolving fraud and money laundering threats in real-time. Our...


  • Phoenix, Arizona, United States DataVisor Full time

    Job OverviewDataVisor stands at the forefront of AI-driven Fraud and Risk Management solutions, offering unparalleled detection capabilities within the industry. Our open SaaS platform facilitates seamless data integration and enhancement, empowering organizations to swiftly respond to evolving fraud and money laundering threats in real time. With our...


  • Phoenix, Arizona, United States State of Arizona Full time

    Job SummaryThis position requires a skilled investigator to evaluate cases for compliance with Labor Department jurisdictional programs. The investigator will conduct investigations primarily from the office, with limited fieldwork as needed.Key ResponsibilitiesReceive and evaluate wage, earned paid sick time, minimum wage, retaliation, youth labor, and...


  • Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full time

    Job Overview: The Administrative Enforcement Section ("AES") is responsible for the investigative and enforcement duties of the Department. This role is crucial in safeguarding the interests of Arizona consumers by ensuring compliance with state regulations. The AES plays a vital role in protecting consumers from unethical practices while fairly enforcing...