Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork
First Resume Review: 09/13/2018
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 a Reinsurance Analyst. This position is one of three staff who administers and coordinates all areas of the AHCCCS Reinsurance Program as related to the contractual agreement with the 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.
* Develop and analyze a variety of Cognos 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 are 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 experience in claims, encounters and/or ICD-9 or 10 Coding.
* Strong customer services skills.
* Demonstrated skills in auditing.
* Demonstrated experience using Microsoft Office and other software: Cognos, Excel, Word and Outlook.
* Demonstrated ability to balance, prioritize and organize multiple tasks, work collaboratively in teams.
* Excellent interpersonal, written and oral communication.
* Knowledge of the Prepaid Medical Management Information System (PMMIS) Reinsurance System.
* One to two years coding and claims experience.
* Two or more years in systems/claims/program auditing in the healthcare industry or closely related experience.
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 [email protected] or call 602-542-4700.