Post Payment Auditor

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.

Post Payment Auditor

Office of Inspector General (OIG)

Job Location:

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

All AHCCCS employees must reside within the State of Arizona.

Posting Details:

Salary: $52,000 - $55,000

Grade: 21

Position will remain open until filled.

Job Summary:

This position will report to an Audit Supervisor in the AHCCCS Office of Inspector General (OIG). This position will be responsible for auditing Providers and Health Plans; providing technical assistance; working interdependently and in a team environment. This individual will be working with Providers, Health Plans, and internal staff to obtain required documentation, process information, analyze, and generate required reports and correspondence.

Major duties and responsibilities include but are not limited to:
• Work with providers to receive necessary data and documentation for post-payment desk and on-site audits. Audit type will be determined based on statistical analysis of a series of factors included in the risk assessment. Providers will be required to submit a completed audit forms with supporting documentation prior to the audit being conducted. A summary of findings will be completed for each audit, with feedback given to all appropriate parties. Individual and aggregate findings will be calculated and reported to state and federal stakeholders and will include trends and indicators by provider type, suggested follow-up and applicable best practices from other states if any actionable barriers or issues are identified. 35% Desk, 5% On-site.
• Evaluating provider attestations, records, and data for validation of AHCCCS incentive program requirements. Determinations will be made to approve or deny. Post payment audit determinations should be communicated with all appropriate parties responsible for processing attestations at the Agency, in accordance with established time frames.
• Researching, monitoring and evaluating best practices and evidence-based interventions for possible implementation by AHCCCS and its stakeholders to improve auditing performance. Recommending quality improvement activities/strategies for implementation and leading or participating in work groups with stakeholders and other stakeholders to implement approved activities/strategies. Examples include but are not limited to local provider/stakeholder forums, national webinars and training sessions, and intra/inter-agency collaborations.
• Participating in system development activities to ensure that AHCCCS - designed systems meet federal and State requirements. This includes researching requirements, meeting to discuss development needs and time frames, participating in review and testing of systems, providing feedback to appropriate parties and supporting underlying processes to ensure timely completion of all related initiatives undertaken.
• Other duties as assigned as related to the position (typically 5% - 10%)

Knowledge, Skills & Abilities (KSAs):

Knowledge:
• American Recovery and Reinvestment Act (ARRA); specifically Health Information Technology, Meaningful Use, and Electronic Health Records
• Basic understanding of physician office practices
• Strong understanding of preventive health, health management and disease management auditing skills and standards
• Project management methodologies
• Statistical, data analysis, and research methods
• Methods of interpreting clinical quality data
• Strong understanding of research and statistical analyses
• State and Federal Polices and Procedures governing Title XIX, Title XXI, Managed Care, LTC and Tribal health care entities
• Healthcare delivery systems nationally and locally, including public health delivery systems
• Background and knowledge of quality management principles and quality improvement organizations (National Committee for Quality Assurance, American Medical Association Physician Consortium for Performance Improvement, Centers for Medicare and Medicaid Services, The Joint Commission)
• Medicaid Managed Care regulations

Skills:
• Excellent computer skills with Word, PowerPoint and Google
• Proficient with Excel and preferably Access
• Strong interpersonal skills in order to effectively relate to multidisciplinary AHCCCS staff, provider representatives, and other stakeholders
• Organizational skills that result in prioritization of multiple tasks and meet deadlines
• Excellent written and oral communication skills, including technical writing report publication
• Above-average mathematical skills
• Interpretation of rules, laws and agency policy pertaining to the AHCCCS program
• Review and evaluation of program activities

Abilities:
• Collaborate and maintain effective working relationships with people in positions of all levels
• Work independently
• Multi-task in a fast-paced environment

Qualifications:

Minimum:
• Two to three years experience working in a Managed Care Organization (MCO).

Preferred:
• Certified Professional in Healthcare Quality. Experience conducting audits and/or monitoring and oversight activities in a healthcare environment.

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 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).

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)

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 here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page

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.

Contact Us:

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. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.

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