Deputy Inspector General

Deputy Inspector General

Office of Inspector General (OIG)

Job Location:

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

All AHCCCS Employees must reside within the state of Arizona.

Posting Details:

Salary:$95,000 -$104,500Grade: 25Position will remain open until filled.

Job Summary:

Under the direction of the Deputy Assistant Director (DAD) and the Inspector General (IG), the Audit Manager exercises direct oversight of Member Compliance by providing assistance, guidance and direct supervision to the three supervisors and their teams. In addition, the Audit Manager provides updates to executive management on a variety of administrative and management issues, projects, initiatives and member related investigations involving healthcare fraud, waste or abuse. The Audit Manager is responsible for ensuring the investigative supervisors and teams are exercising best practices in member healthcare fraud investigations; determining criminal culpability and submitting cases for prosecution and working towards civil remedies when there is no criminal act. The Audit Manager will ensure applicable policies and procedures are followed, updated as needed and communicated with the Member Compliance staff for input.

Major duties and responsibilities include but are not limited to:

Manages audit supervisors of Member Compliance Unit; reports to DAD and IG in regards to asset utilization, investigation(s) status and audit results; recommends changes in operations, policies, procedures when necessary; communicates financial activities, savings and recoupments based on unit activities. Works directly with a prosecutorial agency and AHCCCS Office of General Council (OGC) in the furtherance of a criminal investigation.

Interaction with OIG DAD, IG, AHCCCS Divisions or other State Agencies on projects and initiatives, audits, investigations and/or member/beneficiary status. Participates in the development of AHCCCS OIG annual goals and objectives, policy updates, external audit requests and provides input for system modernization and design. Communicates high level ideas, needs and operational input stemming from meetings, training, or projects

Final review of Member Compliance Units Report of Investigations, and documents that support the final outcome to ensure the evidence is consistent and supportive to the case itself.

Negotiate final determination of overpayment, CMP's and settlements, forfeitures with DAD and IG approval and signature.

Mentor, develop and train subordinates; ensure planners align with the Strategic Plan, Mission, and AMS. Guide staff to understand AMS, and update as necessary the Leader Standards. Review direct staff's position descriptions and update as needed.

Coordinate liaisonships internally and externally.

Knowledge, Skills & Abilities (KSAs):

Knowledge:

Medical health care operations and rules, to include eligibility, concerning the proper handling and accounting of patient trust accounts

Regulations that apply to the various providers who contract with AHCCCS

Rules of evidence

Basic financial and accounting principles

Criminal, civil, and administrative law; Federal Medicaid/Medicare statutes, rules and regulations as they relate to Title19; United States Code and Arizona Revised Statutes; Title 13 and 36

Preparation of detailed computerized spreadsheets

Computerized AHCCCS and Arizona Department of Economic Security (DES) mainframe systems to effectively extract relevant information

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); Specific knowledge including the income and resource requirements for each of these varied programs

Proper methods of interviewing suspects, witnesses and victims, and of the rules regarding the admissibility of statements, admissions, and confessions

State Personnel Rules, EEO and ADA familiarity

Skills:

Investigative process - specifically investigating fraud, healthcare fraud and various fraud schemes; understanding the Arizona prosecution system to include the AZ Attorney General and the County Attorney systems

Computing, summarizing, and aggregating qualitative and quantitative data in an accurate and timely manner

Developing and using spreadsheets and other software tools

Microsoft Office

Interpreting and applying federal and state laws, rules, regulations, and procedures

Organizing, documenting and preparing investigative reports

Working with Metrics and understanding LEAN process/AMS

Written and verbal communications

Interpersonal skills and ability to create relationships with outside agencies and personnel

Support IG with the OIG's Annual Strategic Plan

Conducting investigation and audit data analysis

Communication - verbal and written forms of communication that convey an accurate message. Ability to foster cooperation through effective communication skills

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, research and analyze data

Deal with multiple tasks at one time; See/ listen to multiple sides of an issue

Understand interview and investigative methodology and how to apply it to an investigation to clearly and succinctly state what the problem is, and backed up by evidence to support allegation(s)

Team build. Aptitude to positively affect morale and create a cohesive team

Honesty, forward looking, competent and enable others to act appropriately

Speak publicly and testify

Assist, advise, support, and move forward the IG's vision, goals, and objectives

Collaborate and coordinate with peers related to working with the IG and supporting the strategic direction of the IG

Learn AMS process; LEAN metrics; Leader Standards; Gemba Walks; and Huddle Boards

Travel when needed for training and investigations

Qualifications:

Arizona Driver's License.

Minimum:

Two years experience as an Auditor Supervisor or Manager or closely related field.

Preferred:

Three 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.

Pre-Employment Requirements:

Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agencys 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.)