The Division of Member and Provider Services (DMPS) is looking for a highly motivated individual to join our team as a Customer Service Representative 4. This position is responsible for conducting Provider Enrollment. On-Site Visits, Provider facility compliance with Center for Medicare and Medicaid Services (CMS) Medicaid facility requirements, providing assistance, guidance, and answering questions. During enrollment/application process for AHCCCS Providers. Will assist Providers with application packets in person and over the phone. Interview and question providers to elicit information necessary to determine CMS criteria being met for applicant provider type. Major duties and responsibilities include but are not limited to:
• Assisting AHCCCS Providers in processing their application, answering questions, collecting information.
• Determining eligibility of Provider based on CMS guidelines. Research provider demographics in PECOS, follow CMS audit process/guidelines regarding compliance of Medicare Debt and billing practices and encounters.
• Assess risk level and in-depth screening of Provider to ensure excluded providers are eliminated from Medicaid Review board.
• Studying statutes, rules, policy manual and clarifications. Attending training and conferring with supervisor and others to improve skills and maintain expert level of knowledge.
• Conduct site visits, both individually and in a team of 2, depending on the scope of the visit and distance. Visits will determine the enrollment of services being provided by Provider. Determine those services, offices, and equipment are operable and match information provided on the application completed by Provider.
• Due to COVID-19 precautions the recruiting process has been adjusted to meet the standard health guidelines outlined by the State. Interviews will be conducted virtually and may also be by way of video conference utilizing a platform like Google Meet/Hangouts or Zoom.
• Expert knowledge of CMS State statute.
• Knowledge of rules and regulation relating to the determination of eligibility to become an AHCCCS Provider.
• Knowledge of AHCCCS Provider Enrollment Portal (APEP).
• Skilled in troubleshooting and problem solving
• Skilled in researching methodologies, independent working skills (requiring a minimum of supervision).
• Ability to listen, comprehend and offer guidance to questions surrounding Medicaid enrollment through in-person or telephonic interviews.
Arizona drivers license
• Two and a half years of experience in a multifunctional customer service environment.
• Experience working in medical eligibility, enrollment, claims processing or claims customer service.
• Bilingual (Spanish) is 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 is 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 firstname.lastname@example.org.
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.