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 2

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: $40,000 - $49,000

Grade: 19

FLSA Status: Non-exempt

This position will remain open until filled.

Job Summary:

This position is responsible for conducting investigations to evaluate the accuracy of eligibility determinations for State and Federal programs to prevent ineligible applicants from being approved and discontinuing members who are ineligible to receive benefits.

Major duties and responsibilities include but are not limited to:
• Investigative work to include desk level gathering of evidence and as needed, traveling within the State of Arizona to conduct field and/or desk investigations involving AHCCCS members which includes interviewing members, observing and documenting pertinent information, gathering data and developing sources of information. Utilizing investigative information to write a substantive report that includes evidence review, factual documentation and providing a conclusion that supports or denies a member's eligibility.
• Review and assess information in the case record; analyze data obtained from all sources, case development, assessing the accuracy of the application, determining expenditures for cost benefit analysis and writing investigative summaries and will participate as a witness in the DES grievance process when an investigation was conducted, applicant was ineligible, case denied, and the applicant filed an appeal.
• Planning, scheduling, prioritizing work activity; set up workload controls, determine priorities, monitor activity progress, set goals
• Studying statutes, rules, policy manual and clarifications, attending training and conferring with supervisor and others to improve skills and maintain expert level of knowledge.
• Participate in special projects that may include out of town travel involving residency/eligibility checks of participants as well and on-site audits of certain high risk Medicaid providers. Attend in person trainings and meetings in the Phoenix office.

Knowledge, Skills & Abilities (KSAs):

Knowledge:
• Claims reporting activity
• Microsoft Windows software, Excel spreadsheet software, basic understanding of data base software
• Medicaid Programs and Prepaid Medical Management Information System (PMMIS) and/or DES Eligibility System (AZTECS)
• State statutes, rules and regulations 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

Skills:
• 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
• Verbal and written communication, basic computer skills
• Interpersonal relations as applied to conta