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The position is responsible for identifying complex problems through research, analysis and decision-making skills and finding the correct resources for resolution. Update PMMIS and other subsystems with eligibility, enrollment, demographic, Medicare and other pertinent data. Handle call center calls, answer questions, respond to email escalations or complete problem reports or referrals. Contact other outside agencies such as DES or SSA via email when discrepancies are identified.
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:
• Conducts research and takes action on the most complex case discrepancies utilizing multiple and computer information systems to obtain the information necessary to further quantify the problems and to determine what action or actions need to be taken to correct the discrepancies.
• Resolves problems and reports discrepancies related to eligibility and enrollment using extensive knowledge of policies and procedures related to all AHCCCS eligibility. Following research which includes oral and written inquiries to the eligibility sources, updates systems and documents all actions taken.
• Reads, reviews and applies knowledge of AHCCCS and departmental policies, rules and procedures when working discrepancies to ensure compliance. Keeps current on new policies and procedures. Is back-up to all OCARE call centers by handling incoming calls within the established call center guidelines.
• Is a team resource to answer policy, procedural or systems related questions and helps develop desk level procedures for researching and resolving discrepancies.
Knowledge:
• ALTCS, SSA, DES, Medicare AHCCCS and other eligibility programs and systems.
• Codes, values, logic, system processes which include HEAplus, PMMIS, Medicare, as well as other eligibility systems.
• Experience in dealing with complex types of problems and reports with each of these systems.
• Complete understanding of AHCCCS & DES policies and procedures for all categories and programs regarding eligibility and enrollment.
• Customer service techniques.
• Call center environment.
• Arizona Management System.
Skills:
• Skilled in working independently and taking initiative.
• Expectation technical, analytical, problem solving and decision-making skills.
• Interprets and utilizes complex rules and procedures.
• Strong written and oral communication skills.
• Skilled in the use of computers.
• Strong interpersonal skills.
Abilities:
• Complete heavy workload and special projects quickly and accurately.
• Exercise tact and positive interpersonal interactions.
• Quickly grasp changes and new policy procedures and rules.
• Understand multiple subsystems and to update system data accurately.
Minimum: One year of experience in a multi-functional customer service environment.
Preferred: 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 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.
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 (pilot program).
• 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.
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 Opportunity/Reasonable Accommodation Employer.
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
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