Title: Auditor 3 Location: ,PHOENIX, AZ Job Description: Job No: 540241 Work Type: Full-time REMOTE 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. Auditor 3 Office of Inspector General (OIG) Job Location: Address: 150 North 18th Avenue Phoenix, Arizona 85007 All AHCCCS Employees must reside within the state of Arizona Posting Details: Salary: $49,500 - $53,840 Grade: 21 FLSA Status: Non-Exempt Job Summary: This position conducts complex criminal and civil investigations relating to allegations of Medicaid eligibility fraud, including determining the loss to the AHCCCS program. The responsibilities of this position include but are not limited to: In-depth research investigative report writing, researching Medicaid eligibility rules, policies, statutes. Preparing documentation for eligibility determinations, criminal prosecutions and administrative hearings. Major duties and responsibilities include but are not limited to: - In-depth investigative work to include desk level gathering of evidence, interviewing members and witnesses, observing and documenting pertinent information, gathering data, developing sources of information, and conducting surveillance. As needed, travel within the State of Arizona to conduct field investigations. Utilizing investigative information to write a substantive reports to substantiate allegations of Medicaid fraud for eligibility determinations, including determining the loss to the AHCCCS program, for criminal prosecution, civil actions, and/or administrative hearings. - Compile, analyze and organize Medicaid eligibility records, financial records and other related documents, such as marriage records, real estate records, corporate filing records and various database records, to assess the accuracy of eligibility applications. Calculate expenditures associated with fraud, waste and abuse to determine cost-benefit analysis for potential prosecution, civil actions and/or administrative hearings. - Conduct investigative Internet searches, use and interpret other investigative sources such as; ACJIS, Experian Credit Reports, CLEAR, TLO, Vital Records, Arizona Corporation Commission records and Arizona Motor Vehicle Division reports, etc. - Interpret and apply federal and state regulations, agency rules, and various agency and state policy manuals to make appropriate eligibility determinations. Participate and testify in the appeals grievance process, coordinate with prosecution agencies, and provide Grand Jury and Court testimony. - Participate in special projects that may include out-of-town / overnight travel involving residency/eligibility checks of participants, as well as participate in special projects, such as on-site audits of certain high risk Medicaid providers. Attend in-person trainings and meetings in the Phoenix office. - Prepare and serve subpoenas to obtain evidence necessary to prove or disprove allegations of Medicaid Fraud. Knowledge, Skills & Abilities (KSAs): Knowledge: - Law Enforcement processes and protocols, basic investigative techniques - Interviewing suspects, witnesses and victims, and of the rules regarding the admissibility of statements, admissions and confessions - Thorough knowledge of HIPAA and the rules pertaining to the sharing of investigative information - Relevant statutes and laws pertaining to the investigation of Medicaid fraud, waste and abuse - Income and resource requirements for eligibility for each of these varied programs, Arizona Revised Statutes, State Personnel Rules - Computerized AHCCCS and the Arizona Department of Economic Security (DES) mainframe systems to effectively extract relevant information - Microsoft Windows, Word and Excel, with the ability to prepare detailed spreadsheets to show how the fraud and accompanying loss of funds to the program was occurred - AHCCCS divisions, the services they provide and how they interact with other divisions Skills: - Legal decisions as they relate to the admissibility of evidence, confessions, admissions and statements - Research methodologies, independent working skills (requiring minimal supervision) - Proper methods of interviewing suspects, witnesses and victims, and of the rules regarding the admissibility of statements, admissions and confessions - Effective methods to conduct a covert surveillance operations to identify fraudulent activity - Investigative methods, techniques, and approaches, necessary to plan and conduct criminal, civil and administrative investigations relating to the operations and activities of AHCCCS - Communicate effectively with stakeholders under adverse arid threatening circumstances. Abilities: - Work within a virtual team environment to function effectively in an orderly and purposeful manner in situations of stress or tension - Interpret and apply Federal and State Statutes and Agency policies - Ability to understand the investigative process and apply agency standards - Manage time effectively - Keep Personal Health Information (PHI), Health Information Portability and Accountability Act (HIPAA), and internal state employee cases confidential - Work independently in a virtual office environment with little oversight - The ability to learn and navigate a multitude of agency specific software/programs (PMMIS, HEA, AZTECS, OnBase, etc.) - Present yourself in a calm and professional manner when dealing with difficult and hostile situations - Drive a state vehicle - Ability to travel within the State of Arizona to conduct field investigations, which includes home visits and interviews - Attend in-person meetings, trainings, and other required functions in the Phoenix office Qualifications: Arizona Driver's License. Minimum: - At least two years of experience as an auditor, investigator or equivalent, or eligibility or case worker experience, which includes Medicaid or other public benefits financial policy background. Preferred: - CFE Certification, Bachelor's Degree in Accounting, Healthcare, Criminal Justice or related field, or 4 years of eligibility or case worker experience, which includes Medicaid or other public benefits financial policy background. 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, ARS 13 and 36. Pre-Employment Requirements: - 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 maintain valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed. 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. Learn more about the Paid Parental Leave pilot program here. - 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.

Role Description We are looking for auditors that are excited about the below Mission and Outcomes. Mission: To deliver precise and timely statutory audits that ensure financial transparency and compliance with Hong Kong’s standards, while building trust through clear, prompt communication. We are dedicated to fostering lasting client relationships, empowering informed decisions, and promoting a culture of continuous improvement and integrity. Outcomes: - Deliver all assigned audit engagements within agreed timelines and deadlines. - Prepare accurate and complete audit documentation in line with HKSAs and firm quality standards, with minimal supervision. - Communicate effectively and promptly with clients to gather information, resolve queries, and explain audit findings. - Collaborate with team leaders and other departments to facilitate smooth audit processes. Qualifications - Minimum of 3 years experience as an Auditor. - Must be based in the Philippines or Malaysia. - 2 years experience in managing and executing financial audit assignments preferably for Hong Kong based companies, including but not limited to handling audit, tax, and accountancy assignments. - Strong proficiency in external audit methodology and procedures. - Proven capacity to deliver 8-10 audit reports per month, maintaining high standards of accuracy and quality. - Bachelor degree in Finance, Accountancy, Accounting Technology. - Good command of written and spoken English. - Candidates based in Malaysia must have strong proficiency in Mandarin for this position. - Candidates with relevant experience who can begin work immediately will be prioritized. - Knowledge of Microsoft Excel, Google Sheets, Google Docs. Requirements - Ownership: Reliability and trust within the team. - Humility: Open-mindedness to feedback and willingness to learn. - Structured Thinking: Ability to show sound judgement in complex business scenarios. - Data driven: Use of sound data to support strategies and review success. - Can have tough conversations in a positive way: Proactively addressing difficult interpersonal situations. The Interview Process The successful candidate will participate in the below interview stages. We anticipate the process to last no more than 3 weeks from start to finish. - HR Introductory Call: A ~30 minute HR Introductory call to understand your skills and experience. - Technical Round: A ~30 minute chat with the Hiring team to assess your technical skills. - Soft Skills round: A ~30 minute chat with a member of the leadership team to understand how you think and work. - Offer + reference interviews: A non-binding offer verbally or over email, followed by calls with references. Benefits - Humility and kindness: A culture of not taking ourselves too seriously and being able to laugh. - Flexibility: Ability to work remotely and adjust hours as needed. - Financial benefits: Competitive market salaries, generous paid time off, and eligibility for employee share ownership plan. - Personal growth: Responsibility and autonomy, with various training programmes available.

Role Description This position audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data to support that appropriate reimbursement and clinical severity is captured for the level of service rendered. Provides ongoing education to coders, physicians, and other clinical staff. The incumbent serves in an advisory and educator role for coding and regulatory compliance. Responsibilities - Reviews inpatient medical records post-discharge and pre-bill, audits the accuracy and completeness of diagnoses, procedure coding, abstracted data and DRG assignment. - Reviews non-CC/MCC records to determine if the record was coded correctly or if additional codes may be reported by obtaining documentation supported by clinical indicators and treatment. - Develops and coordinates coding education and formal training programs. - Improves documentation by participating in the CDI query audit process. - Works effectively with the Coding Manager to improve Inpatient coding accuracy. Qualifications - Bachelor's degree or a minimum of six years experience of HIM Management. - Four years of experience with coding ICD-10. - Clinical Coding Specialist (CCS) certification. Licenses Required - One of the following: - Current Certified Documentation Improvement Practitioner (CDIP) through the AHIMA or obtain within 6 months of hire. - Current CCDS Certification with The Association of Clinical Documentation Improvement Specialists (ACDIS). - Additional license requirements as determined by the hiring department. Qualifications (Preferred) - RHIA/RHIT Working Conditions and Physical Demands Employee must be able to meet the following requirements with or without an accommodation. This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions. Physical Requirements - Color Determination - Listening - Manual Dexterity - Near Vision - Sitting - Speaking - Standing

• Plan and coordinate audits, collaborating with site leadership and functional teams to define scope, objectives, and timelines. • Execute internal audits in accordance with AS9100, AS9110, and AS9120 standards, serving as Lead or Team Auditor depending on audit complexity. • Document and report audit findings, collecting evidence, preparing detailed reports, and ensuring all results are actionable and compliant with QMS requirements. • Manage corrective actions, issuing CARs, monitoring progress, supporting root cause analysis, and verifying the effectiveness of improvements. • Support sites and stakeholders, providing guidance on QMS compliance, audit readiness, and opportunities for process improvement. • Contribute to continuous improvement initiatives, leveraging audit findings to enhance quality performance and organizational efficiency. • Travel to internal company sites and regional sites will be required (up to 65%). • Work occasional extended hours to meet audit requirements.