Job Description

05/19/2020
HEALTHCARE SUPPORT 15
PHOENIX 31,000.00-33,020.00

Arizona Health Care Cost Containment System

Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork

Claims Testing Specialist

 

First review: 05/27/2020

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!

JOB SUMMARY:

The Division of Fee for Service Management (DFSM) is looking for a highly motivated individual to join our team as a Claims Testing Specialist. This position analyzes and reviews various reports to ensure claims are paid accurately and no new systems discrepancies are detected. This position issues and tracks tickets for emergency system fixes and tests where program modifications were completed by the Information Service Division (ISD). Major duties and responsibilities include but are not limited to:

* Analyzes and reviews random samples of the pricing report to ensure claims pay appropriately and that no new system discrepancies are detected. Analyzes and reviews various reports to ensure claims are paid accurately. Ensures actions are appropriate and meet current payment policy.

* Identifies and reports system problems and or discrepancies to ensure system integrity. Interacts with manager to report those problems and/or discrepancies or when clarification is needed. When instructed, issues and tracks tickets for emergency system fixes or clarification requests submitted to ISD.

* Tests System Service Requests (SSRs) where program modifications and enhancements were completed by ISD.

* Provides technical assistance to internal and external customers to provide information and/or assistance with claims policy and procedural issues. Communicates effectively, orally and written, providing clear and concise information, and establishes and maintains professional relationships with co-workers, supervisors and managers.

* Participates in continual training to ensure current understanding of AHCCCS/DFSM/Claims Policies and Procedures.

KNOWLEDGE, SKILLS AND ABILITIES (KSAs):

* Intermediate Computer skills

* Skill of interpreting rule and regulations, policies and procedures

* Knowledge of research methodology and processes

* Knowledge of technical writing and problem solving

* Ability to effectively communicate complex information in a clear and concise way

SELECTIVE PREFERENCE(S):

* 2-3 years of experience in Medical Claims Processing or administrative experience

* Knowledge of Prepaid Medicaid Management Information System (PMMIS)

BENEFITS   

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) 417-4678. 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.

Application Instructions

Please apply for this position by following the link provided below. A new window will open on your screen and you will be directed to the Arizona Health Care Cost Containment System (AHCCCS) employment website.

Apply Online