AHCCCS

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

All AHCCCS Employees must reside within the state of Arizona.

Salary: $65,000 - $67,099

Grade: 24

Position will remain open until filled.

This position will supervise the daily activities of the OIG Fraud Prevention Unit. Plan and participate in both internal and external activities of the unit and direct complex audit and investigative functions involving potential violations of both state and federal statutes, rules and regulations, and policies and procedures. May interact with law enforcement, AHCCCS divisions and regulatory agencies to coordinate investigations of overlapping jurisdictions.

Major duties and responsibilities include but are not limited to:
• Provide appropriate direction to investigators for ongoing investigations. Analyzes data collected during the investigation and reports findings to the appropriate place for case disposition. Review completed work assignments, review reports of investigations and make recommendations for change or improvement. Reviews and approves all final case reports.
• Performs effective case and project briefing to the DIG, DAD, and the IG as appropriate. Serves as the final quality control review to ensure that all technical and reporting standards are met. Evaluate, coach, counsel, and provide training.
• Track cost avoidance savings as a result of audits and investigations performed by employees of the fraud prevention unit. Use spreadsheets and case tracking software to deliver metrics and goals set for the unit. Active participant in software modernization projects and seeks future development and growth for FPU duties.
• Supervise the daily activities of the Fraud Prevention Unit, consisting of planning, scheduling, prioritizing work activity, setting up workload controls, determining priorities, monitoring activity progress and setting goals. Ensuring that the CMS, AHCCCS and related policies are applied. Approves annual leave and other related duties.
• Communicates effectively with members of the public and internal staff orally and in writing. Provide new and ongoing training. Identify and develop relationships with other referring agencies such as: Social Security Administration, Department of Transportation and the Department of Child Safety.
• Attends meetings with management to provide updates, discuss recommendations regarding policy issues related to the Fraud Prevention Unit. Reviews national literature and best practices, attends professional conferences and recommends ways to more effectively control fraud and abuse in the AHCCCS program.
• Participate in AMS, development of Metrics and lead measures, establish goals, facilitate weekly huddles, participating in GEMBA walks.
• Other duties as assigned as related to the position (typically 5% - 10%)

Knowledge:
• Preparation of detailed computerized spreadsheets, computerized AHCCCS and the AZ Department of Economic Security (DES) mainframe systems to effectively extract relevant information
• 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)
• Various types of eligibility programs including but not limited to Social Security Disability, Long Term Care program, Supplemental Security Income, Temporary Assistance to Needy Families (TANF) program, and the Sixth Omnibus Budget Reconciliation Act (SOBRA)
• Income and resource requirements for eligibility for each of these varied programs
• Proper methods of interviewing suspects, witnesses and victims, and of the rules regarding the admissibility of statement, admissions and confessions
• State Personnel Rules
• AMS guidelines and LEAN initiatives

Skills:
• Computing, summarizing, and aggregating qualitative and quantitative data in an accurate and timely manner
• Troubleshooting and problem solving
• Research methodologies
• Developing and using spreadsheets
• Interviewing techniques to elicit information
• Effective verbal and written communication with the ability to compose reports, correspondence and policy
• Organizing, documenting and preparing investigative reports
• Interpersonal relations as applied to contact with benefit recipients, landlords, employers, public and private organization representatives

Abilities:
• Motivate people and work within a team environment
• Clearly state what is expected so that there will be no misunderstandings among employees
• Function effectively in an orderly and purposeful manner in situations of stress or tension
• Think analytically
• Deal with multiple tasks at one time
• See/listen to multiple sides of an issue
• Operate a State Vehicle and maintain an AZ Driver's License in good standing

Arizona Driver's License.

Minimum:
• Two years experience as an Auditor or closely related field. Two or more years showing increased workflow responsibilities.

Preferred:
• Two or more years experience providing direct supervision and overseeing daily activities of a section (or) Degree in Criminal Justice or related field or Certified Fraud Examiner (CFE) Certification, or Certified Professional Coder (CPC) and two or more years of responsible investigative experience preferably in government, healthcare, law enforcement, insurance, or managed care organization.
• Four or more years of responsible investigative experience in Government/Healthcare and or Degree in Criminal Justice or related field.

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.

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.