Auditor 3

3 weeks ago

Phoenix, United States Arizona Healthcare Full time

Job Description
Auditor 3
525853
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.
Auditor 3

Office of Inspector General (OIG)

**Job Location**:
**Address**: 801 E. Jefferson Street, Phoenix, AZ 85034

**Posting Details**:
**Salary**: $50,000 - $60,000

**Grade**: 21

Open Until Filled

**Job Summary**:
The Office of Inspector General is seeking to fill two different types of the Auditor 3 position. This position is directly involved in negotiating the final determination of financial over-payments and recommending civil monetary penalties levied against providers participating in fraudulent billing practices.

The information obtained by this position is used for a variety of activities such as: determination of fines, restitution and cost avoidance; internal deliberations regarding settlement amounts for fines and restitution; and participation in the decisions regarding opening and closing of criminal and civil investigations. This position will perform audits/investigations on Fee For Service business providers to establish if program violations have occurred through billing, medical health records, financial documentation.

Major duties and responsibilities include, but are not limited to:

- Complete required health care fraud audits to establish if program violations have occurred regarding provider allegations and/or to verify program integrity in all aspects of OIG to ensure compliance and integrity (Analyze claims, encounter data, review medical records, conduct on-site visits, record interviews, produce high level reports, audit related correspondence, CMP's)

through billing, health care records, financial documentation, access to mainframe computer systems at AHCCCS, DES, MVD and DPS.
- Develop and prepare complex spreadsheets and flow-charts indicating under payments, misuse of funding and billings obtained through the audit process.
- Develop overpayments: losses to the Medicaid Program through diligent research and review in order to present the evidence to the legal authorities for prosecution
- Communicate effectively with the providers and contractors occasionally under adverse arid threatening circumstances. Authority to draft and serve subpoenas and take sworn statements
- Conduct interviews and obtain written statements from providers and clients to determine if fraudulent activities have occurred.
- Prepare written reports for use in administrative or legal proceedings.
- Research Policy and procedures, statutes and changes to Medicaid/Medicare as it relates to compliance, in particular changes to AHCCCS FFS, AIHP, 638/IHS, TRBHA, FQHC
- Ability to analyze and interpret data to effectively communicate the audit results.
- Assist in the review and tracking of Corporate Compliance Deliverables for FFS/AIHP
- Exhibit oral and written communication skills to effectively communicate; produce high level reports and correspondence for internal and external customers; such as Executive Management, Internal AHCCCS
- Divisions and overpayment reports with losses to the Medicaid program for both internal purposes and external, such as; lawyers, MFCU/AG's office.
- Conduct interviews and obtain written statements from AHCCCS providers, and clients as it relates to audit/investigations.

**Knowledge, Skills & Abilities (KSAs)**:
**Knowledge**:

- Law Enforcement processes and protocols, Basic investigative techniques
- Proper methods of interviewing suspects, witnesses and victims
- Rules regarding the admissibility of statements, admissions and confessions
- Thorough knowledge of HIPAA and the rules pertaining to the sharing of investigative information
- Relevant statutes and laws pertaining to the investigation of Medicaid fraud, waste and abuse
- Claims processing, procedures, financing and operations for FFS and MCO
- Preparation of computerized spreadsheets which support audit findings
- Income and resource requirements for eligibility for each of these varied programs
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