AHCCCS

Address: 150 N. 18th Avenue Phoenix, Arizona 85007

Salary: $54,000 - $59,000 

Grade: 21

FLSA Status: Non-Exempt

Closing Date: Open until filled

Under direction from the Provider Relations Manager, this position serves as a liaison between the Fee-for-Service (FFS) program and enrolled service providers to provide direct consultative services and technical guidance related to claims policies and procedures. This position serves as a team lead for the provider relations specialists. This position is also responsible for project managing the resolution of complex claims issues and organizing needed technical assistance and training. This position utilizes independent decision making to resolve high profile, high priority and escalated provider concerns while maintaining positive relationships with external stakeholders.

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.

Major duties and responsibilities include but are not limited to:
• Coordinates and monitors incoming service tickets. Triages and prioritizes service tickets. Distributes service tickets to the service ticket team. Tracks service ticket metrics weekly. Reports service ticket metrics to management.
• Composes professional correspondence for the purpose of technical assistance and claims resolution. Responds completely, accurately, and clearly in writing and verbally to queries about claims matters. Meets with providers virtually and in person.
• Uses professional judgment to identify problems requiring escalation for priority resolution. Resolves escalated claims issues quickly, accurately, and thoroughly.
• Serves as team lead for Joint Operations Committee (JOC) meetings with providers and provider organizations to provide robust technical guidance, including interpreting and explaining billing rules, regulations, and functions. Establishes agendas for JOCs. Take notes for meetings. Follow up on tasks agreed on in meetings.
• Works on long term special claims projects of advanced complexity. Coordinates the resolution of claims problems with other departments such as prior authorization, provider enrollment, finance and information systems.
• Identifies and reports system problems and discrepancies to ensure system integrity. Tracks emergency system repairs submitted to the Information Services Division (ISD).
• Performs complex research tasks as well as special projects for the Provider Relations Manager. Represents the Provider Relations Manager at meetings, workshops, etc.
• Develops and prepares multiple fiscal and operational reports using Cognos. Analyzes reports to identify and resolve claims system problems. Facilitate activities to correct claims problems with other departments. Ensure corrective actions are appropriate and comply with AHCCCS policy and procedure.

Knowledge:
• Concepts of program planning and design
• Laws, regulations and trends pertaining to Medicaid, AHCCCS, and claims
• Local, state and federal programs and resources in the area of assignment
• Advanced knowledge of claims processing
• Extensive knowledge & experience in healthcare industry practices, claims administration to include Medicaid, Medicare, Third Party Liability, insurance policies and regulations

Skills:
• Computer skills with experience in Microsoft programs.
• Excellent written and verbal communication skills to interact effectively with providers and internal staff
• Interpersonal and training skills
• Organizational and planning skills
• Problem identification and resolution
• Researching and interpreting Federal and State laws, statues, rules, regulations, policies, procedures and guidelines

Ability:
• Handle provider inquiries and concerns in a professional and helpful manner
• Identify and resolve issues with providers
• Manage multiple tasks and deadlines effectively
• Learn how to use AHCCCS claims systems such as PMMIS

Arizona Drivers License

Minimum: Three or more years of provider relation and claims experience. Experience working with Medicaid or Healthcare Programs.

Preferred: Policy experience in the areas of Medicaid & experience with project management.

• 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.

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.

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

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)
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child. Learn more about the Paid Parental Leave pilot program here.
• Other Leaves - Bereavement, civic duty, and military.
• 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

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

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 careers@azahcccs.gov.
Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.