Audit Supervisor

AHCCCSArizona Health Care Cost Containment System

• Accountability
• Community
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• Leadership
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• 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.

150 North 18th Avenue Phoenix, Arizona 85007.

Salary: $70,000 - $80,000

FLSA Status:
Exempt

Grade: 24

Position will remain open until filled.

This position is responsible for the development of program integrity operational oversight, primarily for the FFS populations. This position will implement and interpret policies, procedures, standards, and methods for the Provider Compliance Section. Complete and supervise required health care fraud audits and investigations to establish if program violations have occurred through billing or other acts related to fraud, waste, and abuse, performance of special crossover projects between the Office of Inspector General (OIG) and Division of Fee-For-Service Management (DFSM), and/or other Divisions within AHCCCS.

• Complete and supervise required health care fraud audits and investigations to establish if program violations have occurred through billing, health care records, financial documentation, access to mainframe computer systems at AHCCCS, DES, MVD and DPS. Receives and tracks complaints, makes assignments and supervises staff activities.
• Reviews and approves all case reports. Serves as the final quality control review to ensure that all technical and reporting standards are met. Refers completed case reports, as appropriate, to the Attorney General and federal law enforcement agencies.
• Develop and review over payments; losses to the Medicaid Program through diligent research and review in order to present the evidence to the legal authorities for prosecution. Communicates effectively with public and internal staff both orally and in writing.
• Attends meetings with senior management to provide case updates, to discuss civil monetary penalty recommendations, and to discuss policy issues related to the Provider Compliance national literature and best practices, attends professional conferences, and recommends ways to more effectively control fraud and abuse in the AHCCCS program.
• Conduct and supervise investigations during the Audit and or Investigative process. Review written statements taken by investigators from providers and clients to determine if fraudulent activities have occurred.
• Interpret, understand, and analyze information concerning medically oriented programs, management information data, auditing/statistical data, and Medicaid (AHCCCS) services. Conduct and supervise investigators during the Audit and or Investigative process.
• Testify in Administrative Law Judge hearings for civil matters, as well as in Criminal Court as needed for criminal cases.

• Knowledge and experience working with AHCCCS Fee For Service and American Indian Health Plan policy and guidelines
• Criminal, civil and administrative law, Federal Medicaid/Medicare statutes, rules and regulations as they relate to Title 19, 16, & 21, Non Title 19, United States Code
• Arizona Revised Statutes, titles 13 and 36, Arizona Administrative Codes
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