This position will serve as the encounter subject matter expert for AHCCCS and the main encounter contact and technical liaison for the AHCCCCS Contractors. This position is responsible for providing technical assistance to and oversight of encounter submissions of the AHCCCS Contractors.
• Data processing principles, concepts and current practices within AHCCCS and the Contractors
• Claims/Encounter processing, concepts and industry practices
• Appropriate techniques for the analysis of encounter information
• Encounter Data methodology and operations
• Understanding of contractual requirements, policy and procedures related to the submission and oversight of encounter submissions
• Research methodologies
• Professional standards, methods, forms and procedures for the reporting of medical claims/encounter information
• How data is used in research investigations
• Knowledge of Medicaid/Medicare programs and services
• Versed in ICD-9, ICD-10, CPT/HCPCS coding and National Drug Codes
• Thorough knowledge of computerized Prepaid Medicaid Management Information System (PMMIS) and the Transaction Insight Portal
• Word, Access, Excel, PowerPoint, and Outlook
• Team and interpersonal skills
• Oral and written communication skills, including grammar
• Problem solving as it related to position
• Organizational skills
• Analyze complex problems and draw logical conclusions based in information from several sources including plan surveys, and discussions with technical personnel
• Determine if criteria meet research needs
• Interpret and understand documented medical information of a more complex nature
• Express technical information in a clear and concise manner
• Calculate basic statistics
• Communicate effectively when interacting with persons in a variety of settings, including personnel from Contractors
• Obtain cooperation of Contractors and secure acceptance of recommendations
• Speak and write effectively
• Use various computer software applications
Minimum: One year of management analysis experience appropriate to the assignment; OR three years of experience appropriate to the assignment; A Bachelor's or Master's degree in a field appropriate to the assignment will substitute for one or two years of the required experience respectively, but will not substitute for the management analysis experience.
Preferred: Experience with insurance, healthcare claims, contract compliance, auditing, legal environment, Medicaid agency or Medicaid contractor. Proficient with AHCCCS Prepaid Medical Management Information System (PMMIS) 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 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 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 (13 and 12 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.