Arizona Health Care Cost Containment System (AHCCCS)

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Quality Assurance Compliance Officer

at Arizona Health Care Cost Containment System (AHCCCS)

Pay: $45,000 to $50,000/year
$45,000 - $50,000
Posted: 11/18/2020
Job Status: Full Time
Job Reference #: 492747
Keywords:

Job Description

Quality Assurance Compliance Officer

  • 492747
  • PHOENIX
  • AHCCCS
  • Full-time

AHCCCS

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs, and a recipient of multiple awards for excellence in workplace effectiveness and flexibility. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona.

Quality Assurance Compliance Officer

AHCCCS

Posting Details:

Salary: $45,000 - $50,000 

Grade: 21

Job Summary:

The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a Quality Assurance Compliance Officer. Under the direction of the Incentive Programs Supervisor, this position is responsible for the day-to-day activities related to the successful implementation of oversight of the Arizona Promoting Interoperability (PI) Program specifically related to Adopt/Implement/Upgrade (AIU) and meaningful Use (MU). This position will primarily focus on the prepayment audit requirements associated with the PI program, with the majority of time being spent on quality assurance checks for program eligibility.

Job Duties:

* Conduct the prepayment audit verification of the providers' attestation data and supporting documentation, perform analyses, ensure calculations are accurate, evaluate risk based on analysis of a series of factors, determine provider eligibility, authorize payments to eligible providers and document the overall results of the Pre-Payment Audit.

* Implements procedures and systems to administer the program in accordance with CMS and AHCCCS guidelines. Updates and manages data in a complex database structure to track status and funding levels for all participants to this program. Provides program expertise to eligible hospitals and eligible professionals across Arizona. Assists in meeting short-term and long-term project plans for various elements of the program.

* Assists in implementing the State Medicaid Health Information Technology Plan and Audit Strategy. Produces documentation in a clear and structured manner. Reviews provider financial statements and cost reports to determine eligibility and allowable funding levels. Applies data analysis skills to extract meaningful benchmarks from financial data.

* Performs compliance analysis required to make audit payment decisions for which range $5,600 to over $5,000,000. Performs audits of provider financial information to ensure compliance with guidelines of the program. Meets with providers to review financial and contractual data. Amends system data for reconciliations. Researches and responds to payment disputes.

* Support providers through technical assistance and clear/concise documentation requests. Meet with stakeholders (e.g. Health Current) as requested to answer questions and provide feedback on the work that is being done. Provide comprehensive summaries of audit activities, including when appropriate, identified opportunities for future improvement.

* Work with the Office of Inspector General on providers whose attestation data seems to indicate fraud or waste. Support OIG investigation efforts as requested, supplying all relevant documentation for review.

* Participate in system development activities to ensure that the AHCCCS-designated systems meet all the federal requirements for the PI Program. This includes researching requirements, meeting with ISD 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.

Knowledge, Skills & Abilities (KSAs):

* Knowledge of project management methodologies. Statistical, data analysis and research methods. Methods of interpreting clinical quality data.

* Knowledge of State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, LTC and Tribal health care entities.

* Knowledge of healthcare delivery systems nationally and locally, including public health delivery systems. Health care quality improvement practices, performance evaluation and facilitating collaboration among a broad spectrum of stakeholders.

* Skilled in complex analysis, evaluation and resolution of problems. Including organizational skills that results in prioritization of multiple tasks and ability to meet deadlines.

* Excellent written and oral communication skills, including technical writing reports publication.

* Team player with ability to collaborate and maintain effective working relationships with people in positions of all levels. Ability to work independently and produce work products with limited supervision.

Selective Preference(s):

* 2 years’ experience with working with provider and hospital business back-office function

* 2 years’ experience researching and implementing federal healthcare or related policy

* 2 years’ experience with American Recovery & Reinvestment Act (ARRA); specifically Health Information Technology & HER Systems

Benefits:

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.

Application Instructions

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