Senior Healthcare Auditor & Investigator

DGS Office of External Affairs; Phoenix (AZ); On-site; USD 65,000 - 85,000; Full time

Job summary

AHCCCS seeks an Auditor 3 in Phoenix to conduct audits of Fee For Service and Managed Care providers, review claims, medical records, and financial docs, and produce analytical reports. The role involves data analysis, interviews, and ensuring compliance with Medicaid/Medicare regulations and AHCCCS policies.

The Auditor will travel as needed, possess two years of relevant experience, and hold a degree in accounting, healthcare, or related fields.

Qualifications

• Two years' experience as Auditor, Investigator, or equivalent.
• Bachelor's degree in Accounting, Healthcare, Criminal Justice, or related field.
• Knowledge of GAAP/GAGAS and healthcare fraud detection.
• Strong research, data analysis, reconciliation, and communication skills.
• Valid Arizona Driver's License and ability to travel for State business.
• Preferred CPC or CFE Certification or healthcare financial background.

Responsibilities

• Audit and investigate Fee For Service and Managed Care Organization providers.
• Review claims, medical records and financial documentation.
• Analyze data and produce reports for oversight.
• Conduct interviews and verify compliance with Medicaid/Medicare rules.
• Ensure AHCCCS policies are followed during audits.

Skills

Auditing

Investigations

Data analysis

Communication

Education

Bachelor's degree in Accounting, Healthcare, Criminal Justice, or related field

Job description

AHCCCS seeks an Auditor 3 in Phoenix to conduct audits of Fee For Service and Managed Care providers, review claims, medical records, and financial docs, and produce analytical reports. The role involves data analysis, interviews, and ensuring compliance with Medicaid/Medicare regulations and AHCCCS policies.

The Auditor will travel as needed, possess two years of relevant experience, and hold a degree in accounting, healthcare, or related fields.