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Post Payment Auditor

  • Job
    Full-time
    Junior & Mid Level
  • Government & Politics
    Healthcare
  • Phoenix
    Remote

AI generated summary

  • You must reside in Arizona, have 2-3 years in an MCO, pass E-Verify, fingerprint and reference checks, submit a clean driving record, and may need to travel using your own vehicle.
  • You will conduct post-payment audits, evaluate provider data for compliance, research best practices, participate in system development, and collaborate on quality improvement initiatives.

Requirements

  • All AHCCCS employees must reside within the State of Arizona.
  • Two to three years experience working in a Managed Care Organization (MCO).
  • 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.

Responsibilities

  • Work with providers to receive necessary data and documentation for post-payment desk and on-site audits. Audit type will be determined based on statistical analysis of a series of factors included in the risk assessment. Providers will be required to submit a completed audit forms with supporting documentation prior to the audit being conducted. A summary of findings will be completed for each audit, with feedback given to all appropriate parties. Individual and aggregate findings will be calculated and reported to state and federal stakeholders and will include trends and indicators by provider type, suggested follow-up and applicable best practices from other states if any actionable barriers or issues are identified. 35% Desk, 5% On-site.
  • Evaluating provider attestations, records, and data for validation of AHCCCS incentive program requirements. Determinations will be made to approve or deny. Post payment audit determinations should be communicated with all appropriate parties responsible for processing attestations at the Agency, in accordance with established time frames.
  • Researching, monitoring and evaluating best practices and evidence-based interventions for possible implementation by AHCCCS and its stakeholders to improve auditing performance. Recommending quality improvement activities/strategies for implementation and leading or participating in work groups with stakeholders and other stakeholders to implement approved activities/strategies. Examples include but are not limited to local provider/stakeholder forums, national webinars and training sessions, and intra/inter-agency collaborations.
  • Participating in system development activities to ensure that AHCCCS - designed systems meet federal and State requirements. This includes researching requirements, meeting to discuss development needs and time frames, participating in review and testing of systems, providing feedback to appropriate parties and supporting underlying processes to ensure timely completion of all related initiatives undertaken.
  • Other duties as assigned as related to the position (typically 5% - 10%)

FAQs

What is the salary range for the Post Payment Auditor position?

The salary range for the Post Payment Auditor position is $52,000 - $55,000.

Where is the job located?

The job is located at 801 E. Jefferson Street, Phoenix, AZ 85034.

What qualifications are required for this position?

The minimum qualification requires two to three years of experience working in a Managed Care Organization (MCO).

Is travel required for this job?

Yes, travel may be required for State business, and employees will need to meet specific driving record requirements.

What are the major responsibilities of this position?

Major responsibilities include auditing providers and health plans, evaluating provider attestations and records, researching best practices, participating in system development, and generating reports on audit findings.

Are there any preferred qualifications for candidates?

Yes, preferred qualifications include being a Certified Professional in Healthcare Quality and having experience conducting audits in a healthcare environment.

What are the pre-employment requirements for this position?

Candidates must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify) and pass a fingerprint background check, prior employment verifications, and reference checks.

What benefits does AHCCCS offer to its employees?

Benefits include paid holidays, vacation and sick leave, paid parental leave, a robust retirement program, and an affordable insurance plan.

How does AHCCCS promote work-life balance?

AHCCCS offers a full-time or part-time remote work schedule, allowing employees to enjoy improved work/life balance.

Can individuals with disabilities request accommodations during the application process?

Yes, individuals with disabilities may request reasonable accommodations, such as sign language interpreters or alternative formats, by emailing careers@azahcccs.gov.

Government
Industry
10,001+
Employees
1912
Founded Year

Mission & Purpose

Arizona is on a mission to become the #1 state in the nation in which to live, work, play, get an education, and retire. Arizona state government plays a vital role in making this happen, and in order to maximize our potential the State of Arizona must operate in way that demonstrates a business-like approach. We are looking for enthusiastic and talented people to join the team.