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: 150 North 18th Avenue Phoenix, Arizona 85007

All AHCCCS Employees must reside within the state of Arizona

Posting Details:

Salary: $49,500 - $53,840

Grade: 21

FLSA Status: Non-Exempt

This position will remain open until filled.

Job Summary:

This position conducts complex criminal and civil investigations relating to allegations of Medicaid eligibility fraud, including determining the loss to the AHCCCS program. The responsibilities of this position include but are not limited to: In-depth research investigative report writing, researching Medicaid eligibility rules, policies, statutes. Preparing documentation for eligibility determinations, criminal prosecutions and administrative hearings.

Major duties and responsibilities include but are not limited to:
• In-depth investigative work to include desk level gathering of evidence, interviewing members and witnesses, observing and documenting pertinent information, gathering data, developing sources of information, and conducting surveillance. As needed, travel within the State of Arizona to conduct field investigations. Utilizing investigative information to write a substantive reports to substantiate allegations of Medicaid fraud for eligibility determinations, including determining the loss to the AHCCCS program, for criminal prosecution, civil actions, and/or administrative hearings.
• Compile, analyze and organize Medicaid eligibility records, financial records and other related documents, such as marriage records, real estate records, corporate filing records and various database records, to assess the accuracy of eligibility applications. Calculate expenditures associated with fraud, waste and abuse to determine cost-benefit analysis for potential prosecution, civil actions and/or administrative hearings.
• Conduct investigative Internet searches, use and interpret other investigative sources such as; ACJIS, Experian Credit Reports, CLEAR, TLO, Vital Records, Arizona Corporation Commission records and Arizona Motor Vehicle Division reports, etc.
• Interpret and apply federal and state regulations, agency rules, and various agency and state policy manuals to make appropriate eligibility determinations. Participate and testify in the appeals grievance process, coordinate with prosecution agencies, and provide Grand Jury and Court testimony.
• Participate in special projects that may include out-of-town / overnight travel involving residency/eligibility checks of participants, as well as participate in special projects, such as on-site audits of certain high risk Medicaid providers. Attend in-person trainings and meetings in the Phoenix office.
• Prepare and serve subpoenas to obtain evidence necessary to prove or disprove allegations of Medicaid Fraud.

Knowledge, Skills & Abilities (KSAs):

Knowledge:
• Law Enforcement processes and protocols, basic investigative techniques
• Interviewing suspects, witnesses and victims, and of the 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 investi