Audit Compliance Supervisor

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.

Audit Compliance Supervisor

Division of Fee For Service Management (DFSM)

Job Location:

Address: 801 E. Jefferson Street, Phoenix, AZ 85034

Posting Details:

Salary: $73,000 - $78,000

Grade: 22

Closing Date: Open Until Filled

This position has the potential to work from a Virtual Office (VO) setting or may telecommute based on the needs of the unit and at the discretion of leadership.

Must reside in the State of Arizona.

Job Summary:

The Division of Fee For Service Management (DFSM) is looking for a highly motivated individual to join our team as an Audit Compliance Supervisor. Under the direction of the Audit and Prepayment Manager, this position is responsible for the oversight of a variety of audit types including but not limited to Adult Dental, Behavioral Health, Global OB, Inpatient, Outpatient Clinic, Non-emergency, Transportation, Podiatry, etc. This position has the potential of conducting on-site reviews, in support of overall strategic goals of DFSM and AHCCCS leadership.

The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the State's Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.

Major duties and responsibilities include, but are not limited to:

• Overseeing sample audits, reviewing provider records checking compliance with federal and state rules, regulations, and AHCCCS policies and procedures, and identifying recoupment amounts. Oversight of audit staff and development of direct reports.

• Reviews and analyzes regulations and laws applicable to the AHCCCS programs and reports findings to DFSM Leadership.

• Develops procedures and methods to enhancement the program's records submission process. Participate in the development and delivery of trainings related to the improvement of the audit program and related areas.

• Participate in, in-person provider reviews by conducting provider on-site visits with the DFSM Quality of Care units as needed. Participate in internal and external meetings as requested to collaborate with others and ensure full understanding of team and departmental work flows.

• Process the pre-payment reviewed claims. Evaluate and monitor trends in, claims pre-payment and under utilization, data outliers and similar audit related irregularities, in order to provide consistent oversight and technical assistance to the audit unit.

• Facilitate team meetings, huddle boards, monthly Audit Committee and similar meetings. Meet with Claims' Leadership and/or other leaders to discuss overall unit objectives and develop a fluid management plan.

Knowledge, Skills & Abilities (KSAs):

Knowledge of:

• Principles and practices of supervision and staff development.

• Principle and practices of auditing.

• AHCCCS, ALTCS, Medicaid and Medicare Regulations.

• Medicaid and Medicare Federal Regulations, State Statute, Rules, and Policies applicable to AHCCCS programs.

• Advanced knowledge of the behavioral health service delivery system and the needs of children and the needs of individuals designated as SMI.

• Principles of behavioral health management and assessment.

• Fundamental of IHS/638 claims processing and billing.

• AHCCCS Information Management System Prepaid Medical Management Information System (PMMIS).

Skills in:

• Project management of multiple projects.

• Analyze and effectively recommend resolution to provider issues.

• Excellent verbal/written communication skill.

• Organizational skills to coordinate, monitor and report on multiple cases simultaneously.

• Analytical skills to identify and correlate specific patterns, initiate investigations, submit findings and recommendations.

• Strong interpersonal skills in working with people of diverse cultures and socioeconomic backgrounds.

• Strong computer skills including Microsoft and Google Suite.

Ability to:

• Work independently with minimal direction.

• Interpret rules and regulations, policies and procedures as it relates to the program and correctly apply.

• Strong ability to collaborate with others for mutually beneficial outcomes.

• Apply auditing methods and techniques.

• Ability to work Virtual Office or Telecommute or both.

Qualifications:

In possession of a current Arizona Driver's License.

Minimum Qualification:

• Possession of a current license to practice as a registered nurse in the State of Arizona

• Three (3) years professional experience related to health programs appropriate to the assignment, which includes program planning or administration; OR (2) plus years as an AHCCCS Health Care Nursing Consultant.

Preferred Qualification:

• Experience in Behavioral Health services, auditing, American Indian Health plans function and/or experience in claims processing and payment. Managerial experience preferred.

Pre-Employment Requirements:

• Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.

• 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.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.

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 (pilot program).

• 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. For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Retirement:

Lifetime Pension Benefit Program

• Administered through the Arizona State Retirement System (ASRS)

• Defined benefit plan that provides for life-long income upon retirement.

• Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.

• Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program

• Voluntary participation.

• Program administered through Nationwide.

• Tax-deferred retirement investments through payroll deductions.

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.

Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.