Location
Phoenix, AZ | United States
Job description
AHCCCS
Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork
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.
AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. 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.
Come join our dynamic and dedicated team.
Investigative Medical Coder
Office of Inspector General (OIG)
Job Location:
Address: 801 E. Jefferson Street, Phoenix, AZ 85034
Posting Details:
Salary: $50,000 - $60,000
Grade: 21
This position will remain open until filled.
Job Summary:
The Office of Inspector General is looking for a highly motivated individual to join our team as a Investigative Medical Coder. This position is responsible for providing assistance to audits and investigations by using medical coding expertise, assisting in and providing research, analysis, and development including the performance of audits and investigations based on coding issues. Serving as the SME for the OIG in all coding matters; to include case review, testimony, in depth coding analysis and determinations.
Major duties and responsibilities include but are not limited to:
- Perform detailed research and data analysis of referrals, data mining, AHCCCS mainframe and data resources related to issues of fraud, waste or abuse of billing and coding rules and policies. Maintain accurate documentation including case notes for each audit or investigation. Perform case evaluations related to coding and billing issues.
- Perform medical record reviews, CPT coding analysis related to audits and investigations and assist with provider appeals and health plan issues related to billing and coding to perform recoveries.
- Coordinate with various AHCCCS divisions, AHCCCS providers, health plans and other state agencies to support cases with a billing and coding element.
- Conduct meetings, prepare reports for use in administrative or legal proceedings regarding cases with a billing and coding element.
- Attend meetings as required in the OIG and PIT team, participate in team discussions, and prepare and present materials related to billing and coding for the benefit of the OIG and process improvement.
Knowledge, Skills & Abilities (KSAs):
Knowledge:
- HIPAA
- CPT Coding, HCPCS coding, ISD-10
- Encoder Pro, Intellicode
- Medical Terminology
- Claims and Encounter Processing
- Medicare and Medicaid Fraud
- Waste and Abuse statutes
- Microsoft Office (particularly Excel)
Skills: - Data Analytics
- Coding guidelines
- Medical record analysis
- Preparation of detailed spreadsheets
- Problem solving
- Written and verbal communication
- Application of policies statutes and laws
- Research analysis
- Team oriented
- Time Management
Abilities: - Analyze healthcare data for billing and coding issues related to fraud, waste and abuse
- Prepare reports in a clear and concise manner
- Work independently as well as part of a team
- Function in a virtual office environment
Qualifications:
Minimum:
- At least two year's experience as an Auditor or equivalent or Bachelor’s Degree in Accounting, Healthcare, Criminal Justice or Certified Professional Coder.
Preferred: - CPC, 5 years of medical coding experience, additional coding certifications preferred.
- CFE Certification, or Medical or Health Care financial background, or 4 yrs 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.
Pre-Employment Requirements:
- Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
- Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s 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.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.
If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements.
All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).
Benefits:
Among the many benefits of a career with the State of Arizona, there are:
- 10 paid holidays per year
- Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
- Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
- Other Leaves - Bereavement, civic duty, and military.
- A top-ranked retirement program with lifetime pension benefits
- A robust and affordable insurance plan, including medical, dental, life, and disability insurance
- Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
- RideShare and Public Transit Subsidy
- A variety of learning and career development opportunities
By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.
Retirement:
Lifetime Pension Benefit Program
- Administered through the Arizona State Retirement System (ASRS)
- Defined benefit plan that provides for life-long income upon retirement.
- Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
- Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).
Deferred Retirement Compensation Program - Voluntary participation.
- Program administered through Nationwide.
- Tax-deferred retirement investments through payroll deductions.
Contact Us:
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing [email protected].
Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.
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