Description
DEPARTMENT OF ECONOMIC SECURITY Your Partner For A Stronger Arizona.
DES works with families, community organizations, advocates and state and federal partners to realize our collective vision: A thriving Arizona.
DES serves more than 3 million Arizonans. Our Mission is to strengthen individuals, families, and communities for a better quality of life. COMPLIANCE OFFICER Job Location: Address: Division of Developmental Disabilities (DDD)
1789 W. Jefferson Street Phoenix, AZ 85007 Posting Details: Salary: $53,604.30 - $56,453.28
Grade: 20
Closing Date: 02/04/2025 Job Summary:
Would you like to be part of an amazing team that makes Arizonans thrive? At the Arizona Department of Economic Security (DES) we strengthen individuals, families, and communities for a better quality of life. DES is looking for individuals who are committed to service, community, and teamwork. To learn more about DES please visit des.az.gov or click on the link here to view ‘Our DES' video. Come Join the DES Team!
The Department of Economic Security, Division of Developmental Disabilities (DDD), is seeking an experienced and highly motivated individual to join our team as a Compliance Officer. DDD provides individuals with developmental disabilities, and their families, services and supports that are flexible, high quality, and member driven. These services provide individuals with opportunities to exercise their rights and responsibilities of independent decision-making and engagement in the community.
This position may offer the ability to work remotely, within Arizona, based upon the department's business needs and continual meeting of expected performance measures.
The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the State's Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.
Essential duties and responsibilities include but are not limited to:
• Implementing the Compliance work plan; Conducting complex internal compliance investigations and audits. Developing, implementing and monitoring corrective action plans. Resolving non-compliance. Facilitating root cause analysis for non-compliance and high-risk conditions. Internal oversight of organizational compliance with Program Integrity and preparation and execution of regulatory audits.
• Developing and maintaining compliance data bases, tracking tools and auditing tools to enhance ability for data mining. Identifying trends, creating reports from data analysis to monitor and evaluate compliance in related projects and programs. Providing ongoing resources and advising team and management about the Compliance issues. Supporting the activities of the Compliance Committee.
• Developing educational materials related to Corporate Compliance, Medicaid Fraud, Waste & Abuse, and Standards of Conduct. Interpreting of internal monitoring and compliance metrics. Guides management's consistent application of the Compliance Program at the service level. Directs actions to improve gaps in contractual and regulatory compliance.
• Completing external audits to determine compliance with Federal, State and healthcare billing requirements. Evaluates the adequacy and effectiveness of internal and external operational controls. Implementation and monitoring of DDD, District and AdSS corrective action plans. Provides technical assistance to DDD and AdSS in improving compliance with DDD/ AHCCCS/ CMS/CFR standards.
• Processing allegations of fraud, waste and abuse, and misconduct for non-compliance or regulatory violations, including anonymous calls and calls received on confidential hot line.
• Development, implementation and update of policies, procedures and standard work related to Corporate Compliance. Providing recommendations regarding internal or external requests related to AHCCCS policies pertaining Corporate Compliance. Providing guidance in interpreting regulations and health plan guidelines. Engaging with employees on-site to ensure awareness of the Corporate Compliance Program.
Knowledge Of:
• SME on fraud, waste and abuse laws and regulations including, the False Claims Act, Deficit Reduction Act requirements, Anti-Kickback statute, and Stark law provisions.
• SME on Healthcare compliance audit methodologies, principles, and claims processing
• Organizational relationship of the DDD to member and families, AdSS, subcontracted provider network and service provision.
• Contracts, qualified vendor specifications and payment methodologies, Managed care principles and delivery systems. Acute and long-term care principles. AHCCCS and Medicaid policies, statutes, rules, and contract requirements. Federal Medicaid regulations
• Program designs for individuals with developmental disabilities.
Skills In:
• Quantitative analyses using Medicaid enrollment, claims, and program data to support program monitoring, improvement, or evaluation of compliance with contractual requirements, state and federal rules and regulations
• Advanced computer skills to include high proficiency in all MS Office applications (Word, Excel, Access, PowerPoint, Project Plan, OneNote, etc.) with ability to create pivot tables other data reporting mechanisms for requested for analysis.
• Project management skills with the ability to communicate and convey information to a large audience and work with diverse functional areas within the DES-DDD.
• Ability to effectively negotiate and resolve conflicts, and build commitment within the team and others.
• Written and verbal communication skills including editing documents for professional appearance with the ability to prepare reports, data analysis, and risk assessments.
• Interviewing and eliciting information skills in support of project objectives, and strong program planning and evaluation as related to compliance development.
• Researching, investigating, developing, implementing, and monitoring corrective measures. Understanding of organizational data flow and its use in management decision-making.
• Attention to detail. Organizational skills. Time management and self-directed skills. Critical thinking and problem-solving abilities. Serves as lead for Compliance Manager.
Ability To:
• Examine claims and calculate payments, based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
• Assist in the development and revision of policies and procedures; understand and interpret policies, procedures, and regulations; edit and coordinate editing of policies
• Develop and maintain effective working relationships with all levels of Division staff, other programs, agencies, vendors, and the public. Work collaboratively in a highly matrix environment.
• Work cooperatively and effectively on group projects
• Interpret and apply documentation and coding rules and regulations, facility fee charge capture and reimbursement methodologies.
• Develop automated auditing tools, data bases and tracking tools.
The ideal candidate for this position will have:
• A Bachelor's Degree in Public Health, Health Care Administration, business analysis or administration or closely related field or a minimum of five years of equivalent healthcare compliance experience to include data mining and analytics; min three years of experience with internal and external auditing, monitoring, healthcare claims processing, corrective action planning, project management, and process improvement.
• Successfully pass background and reference check; employment is contingent upon completion of the above-mentioned process and the Agency's ability to reasonably accommodate any restrictions.
• All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).
• 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.
The Arizona Department of Economic Security offers a comprehensive benefits package to include:
• Affordable medical, dental, life, and short-term disability insurance plans
• Participation in the Arizona State Retirement System (ASRS) and long-term disability plans
• 10 paid holidays per year
• Vacation time accrued at 4.00 hours bi-weekly for the first 3 years
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
• Sick time accrued at 3.70 hours bi-weekly
• Deferred compensation plan
• Wellness plans
• Tuition Reimbursement
• Stipend Opportunities
• Infant at Work Program
• Rideshare and Public Transit Subsidy
• Career Advancement & Employee Development Opportunities
• Flexible schedules to create a work/life balance.
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.
Learn more about the Paid Parental Leave pilot program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page
Retirement:State employees are required to participate in the Arizona State Retirement System (ASRS), the State sponsored retirement contribution plan and the Long-Term Disability (LTD) program after a 27-week waiting period. The ASRS defined benefit plan provides for life-long income upon retirement. You will also have the option to participate in a voluntary deferred compensation program to take advantage of tax-deferred retirement investments.
On, or shortly after, your first day of work you will be provided with additional information about the available insurance plans, enrollment instructions, submission deadlines and effective dates.
For questions about this career opportunity, please contact us Alyssa Figueroa at 602-653-9837 or alyssafigueroa@azdes.gov.
The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-653-9837 or alyssafigueroa@azdes.gov. Requests should be made as early as possible to allow time to arrange the accommodation.
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