Job: AUDITOR 2(Job Id 37132)

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Job Description

03/30/2018 04/19/2018
ACCOUNTING / AUDITING 19
PHOENIX 33,435.17-46,623.83

DEPARTMENT OF ECONOMIC SECURITY

Providing Opportunity, Assistance and Care for Arizonans in need!

ARIZONA MANAGEMENT SYSTEM (AMS):

All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress.  Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results.  State employees are highly engaged, collaborative and embrace a culture of public service.

Auditor 2

Division of Developmental Disabilities

1789 W. Jefferson Street

Phoenix, AZ 85007

www.azdes.gov

 

JOB SUMMARY:

Conducts claims audits and investigations to effectively pursue the prevention and prosecution of healthcare fraud, waste and abuse, and recover lost funds and comply with regulatory guidelines.  Promotes the health, safety and welfare of individuals with developmental disabilities by developing recommendations of both individual specific and systemic corrective actions and prevention strategies and the monitoring thereof. 

 

Performs audits of billing code utilization and documentation practices for internal claims as well as claims processed by the Division's subcontracted Health Plans. Documents and tracks all audit findings to include recommendations for provider training, reversals of identified fraudulent claims and implementation of system controls.

 

Upon completion of audits, writes and submits clear, concise, and logical quality reports.  Ensures corrective actions are documented and completed according to the report recommendations.  Recommends closing the audit once all corrective action(s) are complete.  Provides guidance, assistance & recommendations to staff in determining appropriate decisions for corrective actions.

JOB DUTIES: 

-          Performs audits of billing code utilization and documentation practices for internal claims as well as claims processed by the Division's subcontracted Health Plans.

-          Documents and tracks all audit findings to include recommendations for provider training, reversals of identified fraudulent claims and implementation of system controls.

-          Upon completion of audits, writes and submits clear, concise, and logical quality reports.  Ensures corrective actions are documented and completed according to the report recommendations.  Recommends closing the audit once all corrective action(s) are complete.  Provides guidance, assistance & recommendations to staff in determining appropriate decisions for corrective actions.

-          Facilitates the recovery of federal and state money as a result of inaccurate provider payment, including fraud, waste and abuse matters.

-          Identifies incorrect provider and internal coding and billing to prevent current and future payment of fraudulent claims.

KNOWLEDGE, SKILLS AND ABILITIES (KSAs):

Knowledge of:

-          Principles and practices of auditing and claim processing

-          Rules and regulations as they pertain to processing claims, claim policies and procedures, and national and Arizona medical coding standards (CPT, ICD-9, ICD-10 and HCPCS)

-          Medical and behavioral health auditing and compliance concepts

-          Arizona Health Care Cost Containment System (AHCCCS) programs, policies, procedures and systems

Skill in:

-          Strong analytical and research

-          Oral and written communication

-          Proficient in researching information utilizing Word, Excel, MS Outlook, database search tools, and the Internet

Ability to:

-          Interaction with different groups of people at different levels and provide assistance on a timely basis

-          Apply audit methods and techniques

-          Interpret federal and state laws

-          Analyze and organize information and data

-          Oversee and complete multiple projects

SELECTIVE PREFERENCE(S):

-          Candidate must possess at least 2 years' professional experience related to health programs in medical coding and/or medical auditing and compliance. Bachelor's degree preferred.  Any combination of training and experience meeting the Knowledge, Skills, and Abilities (KSAs) substitutes for the degree on a year-for-year basis.

PRE-EMPLOYMENT REQUIREMENTS: 

-          Required at time of appointment:  Possession of or in the process of possessing one of the following (or similar) American Academy of Professional Coder (AAPC) or American Health Information Management Association (AHIMA) certifications: Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Registered Health Information Technician (RHIT), Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC).  Within 6 months of hire must possess the certification for continued employment.

BENEFITS: 

 The Department of Economic Security offers a comprehensive benefits package to include: 

-          Sick leave

-          Vacation with 10 paid holidays per year

-          Health and dental insurance

-          Retirement plan

-          Life insurance and long-term disability insurance

-          Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance

RETIREMENT: 

Positions in this classification participate in the Arizona State Retirement System (ASRS). 

Please note, enrollment eligibility will become effective after 27 weeks of employment.

CONTACT US: 

If you have any questions please feel free to contact 602.542.6868 for assistance.

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-364-3981. 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.