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.

Job Location:

Address: 150 North 18th Avenue Phoenix, Arizona 85007

All AHCCCS Employees must reside within the state of Arizona.

Posting Details:

Salary: $50,000 – $57,000

Grade: 21

FLSA Status:
Non‑Exempt

This position will remain open until filled.

Job Summary:

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, participate in the decisions regarding opening and closing of criminal and civil investigations.

Major duties and responsibilities include but are not limited to:

• Complete 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.
• Develop and prepare complex spreadsheets and flow‑charts indicating under payments, misuse of funding and billings obtained through the audit process.
• Develop over payments: 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.
• Testify in Administrative Law Judge hearings for civil matters, as well as in Criminal Court as needed for criminal cases.

Knowledge, Skills & Abilities (KSAs):

• Knowledge: Law Enforcement processes and protocols, Basic investigative techniques; interviewing suspects, witnesses and victims, and 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 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, Arizona Revised Statutes, State Personnel Rules.
• Skills: Legal decisions as they relate to the admissibility of evidence, confessions, admissions and statements;
  Proper methods of interviewing suspects, witnesses and victims, and the rules regarding the admissibility of statements, admissions and confessions;
  Effective methods to conduct a covert operation to identify fraudulent activity, Investigative methods, techniques, and approaches, necessary to plan and conduct criminal, civil and…