Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork
Quality Assurance Compliance Officer
First Resume Review: 11/27/2019
This position to remain open until filled.
Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid Agency, is driven by the passion to deliver comprehensive and cost effective health care to Arizonans in need. AHCCCS is nationally acclaimed as a model for other Medicaid programs and recipient of multiple awards for excellence in workplace effectiveness and flexibility.
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. Visit our careers page to learn more about AHCCCS. Use your skills to benefit others; join the AHCCCS Team!
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 (Pl) Program specifically related to Adopt/Implement/ Upgrade (AIU) and Meaningful Use (MU). This position will primarily focus on the pre-payment audit requirements associated with the Pl Program, with the majority of time being spent on quality assurance checks for program eligibility. Major duties and responsibilities include but are not limited to:
* Conduct the pre-payment 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 payments which range from $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 Pl 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 AND 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.
* 2 year’s experience with working with provider and hospital business back-office function
* 2 year’s experience researching and implementing federal healthcare or related policy
* 2 year’s experience with American Recovery & Reinvestment Act (ARRA); specifically Health Information Technology & EHR Systems
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. Click here to learn more about benefits.
Arizona State Government is an EOE/ADA Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by calling (602) 417-4497. Requests should be made as early as possible to allow sufficient time to arrange the accommodation. AHCCCS is an Equal Employment Opportunity Employer. All newly hired employees will be subject to E-Verify Employment Eligibility Verification.
Click the APPLY NOW button to submit your application.
For technical assistance, email HRIShelpdesk@azdoa.gov or call 602-542-4700.