AHCCCS

Address:  801 E. Jefferson Street, Phoenix, AZ 85034

Must reside in the state of Arizona.

Salary:  $56,000 - $58,000

Grade: 20

Closing Date: Open Until Filled

This position is eligible for full-time remote work (including virtual office arrangement in Arizona).

A career in public service awaits you. COME JOIN OUR TEAM!

A great benefit of working for the State of Arizona is a fantastic work/life balance. State employees enjoy challenging work, popular remote work options, comprehensive health and wellness benefits, and career growth opportunities.

We are searching for someone who will be comfortable and confident working independently on our team. You’ll have the opportunity to take on complex issues and make solid decisions to implement what needs to be done. If you’re looking for a great foundational position where you will learn about health plans and work with contractors and be coached, mentored and trained to be successful in your career with AHCCCS - this is the position that you've been waiting for –  Come work with us!

What You'll Do:

You will serve as an encounter subject matter expert and provide analytical support and technical expertise for encounter (post adjudicated claim) operations. Additionally, you'll manage Contractor encounter submissions from EDI submissions to mainframe processing, ensuring accuracy, completeness, and timeliness.

Major duties and responsibilities include but are not limited to:
• Provide analytical support and technical expertise for encounter operations in all or some of the following areas claims/encounters, PMMIS (Prepaid Medical Management Information System) subsystems and reporting, technical and policy documents.
• Monitor Contractor encounter submissions, adjudicating pending encounters, while identify trends, areas of non-compliance and provide detailed analysis following mainframe processing cycles.
• Utilize operational/management reports to ensure Contractors’ encounter processing meets all contractual requirements and benchmarks, reporting areas of non-compliance to Encounter Manager, implement and administer corrective action to return Contractor to compliance.
• Respond timely to external and internal points of contact with the encounter unit (i.e., Encounters and Transaction Portal Insight e-mail boxes, & SFTP Site).
• Lead the development and facilitation of encounter standard work, training, and education for internal and external stakeholders.
• Participate in Operational Review and Ad Hoc projects of the Contractors.
• Participate in State-wide AMS & LEAN initiatives, continually analyzing current processes for opportunities for automation and inefficient redundancies within the unit, department, and division.

Knowledge:
• Principles and practices of public administration with emphasis on effective planning, organization, and management
• Business operations and rules
• Principles and techniques of automated information systems analysis, design, modification, and implementation
• Principles, research methods and reporting techniques.
• AHCCCS policies and procedures
• State and Federal Rules/Regulations

Skills:
• Excellent written, oral, and interpersonal communication skills
• Demonstrated ability to work collaboratively in teams and across organizations
• Strong customer service skills
• Problem analysis and solving skills

Abilities:
• Balance, prioritize and organize multiple tasks
• Build strong relationships inside and outside the organization
• Work in a remote environment

Minimum:
• Two years of management analysis experience appropriate to the assignment; OR four 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.

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.