Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork
First Resume Review: 07/01/2019
This position will remain open until filled.
Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid Agency, is driven by the passion to deliver comprehensive and cost effective health care to Arizonans in need. AHCCCS is nationally acclaimed as a model for other Medicaid programs and recipient of multiple awards for excellence in workplace effectiveness and flexibility.
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. Visit our careers page to learn more about AHCCCS. Use your skills to benefit others; join the AHCCCS Team!
The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as an Auditor 2. This position administers and coordinates all areas of the AHCCCS Reinsurance Program as related to the contractual agreement with the 19 AHCCCS Health Plans and Program Contractors, and reimbursement for transplant related services for nine Indian Health Services (IHS) Fee-For-Service (FFS) plans. This staff member will determine compliance with contractual agreements for Reinsurance consideration for acute, catastrophic and transplants. Major duties and responsibilities include but are not limited to:
* Audit PMMIS encounters and reinsurance payments to ensure that they are appropriately encountered by the contractor and processed. Use knowledge of coding and claims as well as AHCCCS Reinsurance processing rules to assist the Contractor when necessary in identifying impediments to processing through PMMIS
* Audit critical monthly reports to ensure Contractors program compliance and make necessary recommendations when needed
* Audit, Research and Adjudicate Reinsurance claims based on interpretation of AHCCCS Policies, Procedures and Contracts and laws
* Audit and Process Catastrophic & Transplant Reinsurance cases for adjudication and payment
* Communicate with internal and external personnel on a daily basis including by phone or email. Provide technical system/training support to external and internal users including assisting with the annual training conducted by the Reinsurance team
* Develop and analyze a variety of data warehouse reports and Excel workbooks for paid adjudicated encounters and reinsurance payments to ensure that encounters are appropriately submitted by the contractor and processed so that they will included in the data used by the actuaries when developing managed care capitation rates
* Provide technical system/training support to external and internal users. Assist with Technical Assistance to Health Plans and participate in the Quarterly Contractor Workshops
KNOWLEDGE, SKILLS AND ABILITIES (KSAs):
* Demonstrated knowledge in systems or program auditing in a healthcare environment
* Software applications including but not limited to: Excel, Cognos and PowerPoint
* Interpret federal and state laws as well as agency contracts and policies
* Work effectively with a variety of people including the ability to communicate with a variety of audiences and various levels of management
* Organizational skills that result in prioritization of multiple tasks
* Ability to reason, form concepts and solve problems using unfamiliar information or new procedures
* Plan, organize and multi-task to ensure completion of multiple work assignments within required timeframes
* Five+ years as systems/programming auditing in healthcare industry coding claims
* Knowledge of AHCCCS/Administrative policies and procedures
* Experience working in PMMIS
At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan. Click here to learn more about benefits.
Arizona State Government is an EOE/ADA Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by calling (602) 417-4497. Requests should be made as early as possible to allow sufficient time to arrange the accommodation. AHCCCS is an Equal Employment Opportunity Employer. All newly hired employees will be subject to E-Verify Employment Eligibility Verification.
Click the APPLY NOW button to submit your application.
For technical assistance, email HRIShelpdesk@azdoa.gov or call 602-542-4700.