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Title : Auditor 2

Title : Auditor 2

Arizona Health Care Cost Containment SystemPhoenix, AZ
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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 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 as on-site audits of certain high risk Medicaid providers.

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 contact with benefit recipients, landlords, employers, public and private organization representatives
  • Use of tactful diplomacy due to the nature of the job

    • Abilities :

  • Work within a team environment, function effectively in an orderly and purposeful manner in situations of stress or tension
  • Work with the public in less-than-ideal conditions
  • Deal with multiple tasks at one time
  • Successfully work and be productive in a virtual environment
  • Work independently at times with little oversight
  • Ability to travel within the State of Arizona to conduct field investigations, which includes home visits and interviews

    • Qualifications :

    Arizona Driver License.

    Minimum :

  • Experience in auditing work, investigations or public benefits eligibility.

    • Preferred :

  • Bachelor’s degree in accounting, Healthcare, Criminal Justice or closely related field. Experience of the rules regarding the admissibility of statement, and confessions; Title 19 and ASRS title 13 & 36.
  • Bilingual (Spanish) is a plus.

    • Pre-Employment Requirements :

  • 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.)

    • 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. Learn more about the Paid Parental Leave pilot program here.
  • 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)
  • RideShare and Public Transit Subsidy
  • A variety of learning and career development opportunities

    • 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.

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