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Job Information
Job Title:  MEMBER FRAUD INVESTIGATOR - TUCSON 
Agency:  ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - AHCC 
Job Reference ID:  53318 
Category:  INVESTIGATIONS/COMPLIANCE 
Grade:  21 
Posted Date:  04/09/2020 
Close Date:   
Job Description



 

Arizona Health Care Cost Containment System

Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork

 

 

Member Fraud Investigator - Tucson

 

First Resume Review: 02/28/2020

 

 

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!

 

JOB SUMMARY:

The Office of Inspector General is looking for a highly motivated individual to join our team as a Member Fraud Investigator – Tucson location . This position conducts complex criminal and civil investigations relating to allegations of Medicaid eligibility fraud. Major duties and responsibilities include but are not limited to:

 

Conducts in-depth investigations that include field investigations, surveillance, interviewing and interrogating subjects or witnesses in their home or agency’s office.    

 

Compiles, analyzes, organizes, Medicaid eligibility records, financial records and other related documents; Composes detailed reports of investigations to submit to prosecuting agencies for criminal prosecution and/or administrative action.

 

Conducts investigative internet searches, uses and interprets other investigative sources such as; ACJIS, Experian Credit Reports, CLEAR, Lexis Nexus, Vital Records, AZ Corp. Commission, NWSC, AZ MVD reports, etc.

 

Collects, examines, and preserves information, documents, and records for evidence.  

 

Interprets applicable, federal and state laws, agency rules, regulations and policy regarding Medicaid eligibility and criminal violations

 

Serves Subpoena’s to obtain necessary evidence to prove or disprove allegations of Medicaid Fraud

 

This position also participates in special projects that may include out of town travel involving residency/eligibility checks of participants as well and on-site audits of certain high risk Medicaid providers. Must be willing to travel overnight if necessary.

 

KNOWLEDGE, SKILLS AND ABILITIES (KSAs):

Knowledge of Criminal, civil and administrative law, Federal Medicaid/Medicare statutes, rules and regulations as they relate to Title 19, 16, & 21 United States Code and additional knowledge of Arizona Revised Statutes, titles 13 and 36

 

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

 

The 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 eligibility for each of these varied programs

 

Ability to interpret and apply Federal and State Statutes and Agency policies

 

Conduct investigations, Manage time effectively, deal with difficult situations in a calm manor, Effectively handle hostile situations

 

Skilled in: Legal decisions as they relate to the admissibility of evidence, confessions, admissions and statements

 

SELECTIVE PREFERENCE(S):

Preference given to persons with CFE Certification, or Medical or Health Care background, or 4 years of eligibility experience, or a 4 year degree from accredited university in a closely related field. Knowledge of: Proper methods of interviewing suspects, witnesses and victims, and of the rules regarding the admissibility of statements, admissions and confessions, and Title 19, ASRS 13 and 36.

 

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. 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) 417-4678. 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 [email protected] or call 602-542-4700.

 

 
Position Requirements
Position Level:    Hours:   
 Work Arrangement:     Employment Type:   
Hourly Rate:  $0.00 / per hour  Salary:  $44,000.00-46,500.00 

 

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