Fee For Service Audit Investigator – State of Arizona – Phoenix, AZ

The Office of Inspector General is looking for a highly motivated individual to join our team as a Fee For Service Audit Investigator. The incumbent will perform audits/investigations on Fee For Service business providers to establish if program violations have occurred

Job Duties:

  • Conduct internal and external audits/investigations pertaining to AHCCCS FFS, AIHP, 638/IHS, TRBHA, and FQHC business regarding provider allegations and/or to verify program of integrity in all aspects of OIG to ensure compliance and integrity (Analyze claims, encounter data, review medical records, conduct on-site visits, record interviews, produce high level reports, audit related correspondence, CMP’s).

  • Research Policy and procedures, statutes and changes to Medicaid/Medicare as it relates to compliance, in

  • Ability to analyze and interpret data to effectively communicate the audit results

  • Assist in the review and tracking of Corporate Compliance Deliverables for FFS/AIHP

  • Exhibit oral and written communication skills to effectively communicate; produce high level reports and correspondence for internal and external customers; such as Executive Management, Internal AHCCCS Divisions and overpayment reports with losses to the Medicaid program for both internal purposes and external, such as; lawyers, MFCU/AG’s office.

  • Conduct interviews and obtain written statements from AHCCCS providers, and clients as it relates to audit/

Knowledge, Skills & Abilities (KSAs):

  • Knowledge of: AHCCCS Fee For Service and American Indian Health Plan policy and guidelines. Research, communications and briefings techniques; government process experience related to: auditing, process improvement, Medicaid/Medicare or behavioral health, data collection/metrics, medical coding/billing and encounters, reconciling records, and program management.

  • The auditor must have extensive knowledge of accounting principles and practices in accordance with the Generally Accepted Government Auditing Standards (GAGAS) data validation and focused audits.

  • Skilled in: research, mathematics, financial reconciliation processes, data analysis, problem solving, computer skills that include Microsoft Office, and Google Docs.

  • Ability to: analyze, interpret and communicate data, communicate effectively both verbally and in writing, conduct performance audits, understanding the process and administrative function, perform accurate and timely work with minimal supervision.

  • Interpret and explain financial, operational and administrative information, take initiative. Work in a team environment, plan, summarize and analyze large amount of complex information and data and to present information in a clear and concise fashion into a formal reporting document.

Selective Preference(s):

  • 2-3 years of work experience related to/in Analytical Background or 5 years of Audit Experience.

  • 3 – 5 years of experience and understanding of the AHCCCS DFSM Division with a working knowledge of OIG process and procedures.

  • Strong computer skills, understanding the importance of data collections in accordance with the Generally Accepted Government Auditing Standards (GAGAS)

Pre-Employment Requirements:

  • Arizona Drivers License


At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan.

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

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.

Source: Indeed.com
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