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DISPUTE AND APPEAL MANAGER

  • 502524
  • PHOENIX
  • DEPT OF ECONOMIC SECURITY
  • Full-time

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 that every child, adult, and family in Arizona will be safe and economically secure.

DES serves more than 3 million Arizonans Our Mission is to make Arizona stronger by helping Arizonans reach their full potential through temporary assistance for those in need, and care for the vulnerable.

DISPUTE AND APPEAL MANAGER
Division of Developmental Disabilities (DDD)
www.azdes.gov 

Job Location:

Address:  4000 N. Central Avenue - Phoenix, AZ 85012

Posting Details:

Salary: $60,354 - $77,468 

Grade: 22

Closing Date: Open Until Filled

Job Summary:

Would you like to be part of an amazing culture that helps Arizonans reach their full potential through temporary assistance? The Arizona Department of Economic Security (DES) is looking for individuals that are committed to service, community, and teamwork.

The Department of Economic Security, Division of Developmental Disabilities (DDD), is seeking an experienced and highly motivated individual to join our team as a Dispute and Appeal Manager. 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.

Job Duties:

• Reviews and approves all proposed resolutions of service delivery claim disputes, grievances, and appeals (member, client parent, acute care, and long-term care providers) before they are forwarded to the Assistant Director
• Reviews and approves requests and communications between the Division and the Attorney General’s Office for claim disputes, grievances, appeals, fair hearings, litigation settlements, subpoenas, summons, requests for records, and informal and formal legal opinions
• Reviews all rules, regulations, laws, legal opinions, etc. and analyzing impact on Division operations; designs and develops the process used for providers, members, families, advocates, and other stakeholders regarding claim disputes, grievances, appeals and fair hearings; designs and develops programs and procedures to monitor and review all acute care and long-term care programs
• Provides technical assistance to acute care/long-term care providers and Division staff regarding claim disputes, grievances, appeals, fair hearings, and related federal and state regulations, rules, policies, and procedures; and performs other additional duties as required

Knowledge, Skills & Abilities (KSAs):

Knowledge of:
• Department and Division programs and activities; DES, Arizona Health Care Cost Containment System (AHCCCS), Arizona Department of Administration (ADOA), Department of Health Services (DHS), and other State government agencies and state service policies, procedures, and operations
• Federal, state and county laws and judicial systems; statutes, rules and regulations and their development and adoption
• Grievance, appeal and fair hearing rules and regulations outlined in the Balanced Budget Act of 1997; acute health care policies and practices, including claim adjudication, fraud and abuse, ethics, service delivery and contract compliance
• Federal and state requirements with regard to the privacy of health information; management practices and procedures; contracts management
Skill in:
• Leadership in the development and implementation of administrative, technical, and physical safeguards to protect the privacy of health information
• Oral and written communication including public speaking
• Time management (e.g., planning, organizing, directing, controlling, etc.)
• Developing management and operational analysis of programs and activities
Ability to:
• Interpret and apply statutes and agency and division policies and procedures
• Provide sound interpretation of the federal Health Insurance Portability and Accountability Act (HIPAA) that directly impacts the maintenance of health information
• Analyze information and data involving appeals and claim disputes
• Analyze and interpret and understand how insurance rates are developed for acute care and long-term care services

Selective Preference(s):

• The candidate must possess (3) years of managerial experience in human services programs or in direct support of such programs which developed knowledge of the programs and insight into their function. A Master’s degree in business or public administration or closely related field from an accredited college or university substitutes for (1) year of the required experience

Pre-Employment Requirements:

• In-state travel is required. This position requires possession of and the ability to retain a current, valid state issued driver’s license appropriate to the assignment. Employees who drive on state business are subject to driver’s license records check, must maintain acceptable driving records and must complete any required driver training (see Arizona Administrative Code R2-10-207.12). 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
• In accordance with the Arizona Health Care Cost Containment System contract as defined in 42 CFR 455, 104, SMDL#09-01, a search for the incumbent monthly using the List of Excluded Individuals and Entities (LEIE) and the System for Award management (SAM).
• Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
• Successfully pass background and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.

Benefits:

We offer a competitive benefits package that is unmatched by the private sector and a culture that encourages team success and advocates for personal advancement.

• Affordable Health, Dental, Vision and Life and Disability Insurance
• 10 holidays per year
• Paid Vacation and Sick time off - start earning it your 1st day
• Eligible to participate in the Public Service Loan Forgiveness Program (must meet qualifications)
• Contribute to, and participate in the Arizona State Retirement System
• Ride Share and Public Transit Subsidy
• Career Advancement Opportunities
• Tuition reimbursement
• Opportunity to work remotely (home office) on an ad-hoc basis

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.

Contact Us:

Apply through azstatejobs.azdoa.gov. For questions about this career opportunity, please call Pio Guillen (602) 402-6411 or email ElpidioGuillen@azdes.gov.

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting (602) 402-6411. 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.