The Division of Fee for Service Management (DFSM) is looking for a highly motivated individual to join our team as a Claims Customer Service Representative 2. After a successful training period, this position will work primarily from home, with some in-office meetings and on-site duties being required. This position performs administrative work in the Claims Customer Service Unit in the division of Fee for Service Management (DFSM) in a call center environment. It is responsible for specialized work with AHCCCS providers regarding the status of their claims. Major duties and responsibilities include but are not limited to:
• In a virtual call center environment, provides technical assistance to providers and agency staff regarding billing procedures, reimbursement policies, prior authorization requirements and eligibility information.
• Research provider claims, and prior authorization inquires to provide status and identify billing, procedure, or processing problems. Refers to appropriate areas for additional claim research if needed.
• Collects documentation for resubmission of claims and prior authorizations. Assures quality of claims in each phase of the claims process.
• Prepares documentation for research and coordinates resolution of provider issues between various claims departments.
• General knowledge of all AHCCCS and Fee for Service Programs.
• Excellent verbal and written communication skills.
• Intermediate computer skills.
• The ability to elevate a situation/issue to a higher level.
• Multi-task in a fast-paced environment.
•1 yr. experience in a multifunctional customer service environment.
• Experience working in the medical eligibility, enrollment, claims processing or claims customer service. Bilingual (Spanish) a plus.
• 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 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.
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 (12 and 13 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
• 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
• Opportunity to work 100% virtually or remotely on an ad-hoc basis (home office)
By providing the option of a full-time or part-time virtual/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.
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
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.
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing email@example.com.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.
ARIZONA MANAGEMENT SYSTEM (AMS)
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.
The State of Arizona is an Equal Employment Opportunity Employer.