Title: PROGRAM PROJECT SPECIALIST 1
PROGRAM PROJECT SPECIALIST 1
- REMOTE OPTIONS
Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork
The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.
AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.
Come join our dynamic and dedicated team.
PROGRAM PROJECT SPECIALIST 1
Division of Fee For Service
Address: 801 E. Jefferson Street, Phoenix, AZ 85034
Open to filled: 1st review of resumes on 01/11/2023
This position may offer the ability to work remotely within Arizona based upon the department's needs and continual meeting of expected performance measures.
The Division of Fee For Service Management is looking for a highly motivated individual to join our team as a Program Project Specialist 1. This position is responsible for developing and preparing operational reports, coordinates and monitors the operations of claims, and performs complex administrative and research task for claims operations.
Major duties and responsibilities include but are not limited to:
- Develops and prepares multiple fiscal and operational reports using Cognos. Analyzes reports to identify and resolve claims system problems. Facilitates activities to correct claims problems with other departments. Ensures corrective actions are appropriate and comply with AHCCCS policy and procedure.
- Coordinates and monitors the operations of the claims portion of the ticket system. Identifies and reports system problems and discrepancies to ensure system integrity. Issues and tracks tickets for emergency system fixes or clarification requests submitted to the Information Services Division (ISD).
- Performs complex administrative & research tasks as well as special projects for the Claims Operations Administrator. Represents the Claims Operations Administrator at meetings, workshops & seminars. May be delegated to supervise clerical or technical personnel in absence of the Claims Operations Administrator or managers in the claims department.
- Meets with provider organizations to interpret and explain billing rules, regulations and functions. Composes professional correspondence to provider organizations and stakeholders on claims issues.
- Tracks and facilitates the resolution of escalated claims issues and special claims projects of advanced complexity. Coordinates resolution of claims problems with other departments such as prior authorization, provider enrollment, finance, and information systems.
- 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, concise information. Establishes and maintains professional relationships with AHCCCS co-workers and supervisors.
- Recommends, develops, and modifies claims procedures and forms to improve billing effectiveness.
- Participates in continual training to ensure current understanding of AHCCCS/DFSM/Claims Policies and Procedures.
- Medical terminology
- Claims processing
- Research methodology
- AHCCCS Polices and Procedures
- AHCCCS Fee for Service reimbursement polices
- Intermediate level of proficiency within Microsoft Excel (Ability to data sort, filter, pivot tables); (Ability to create and edit documents).
- Excellent verbal and written communication skills.
- Customer Service
- Analyze reports
- Professional interpersonal relationships
- Analyze problems and develop action plans for correction
- Critical/logical thinking and decision making
- Coordinate and work with others as needed
- Effectively communicate complex information concisely
- Effective verbal and written communication
- Prioritize frequently during the day to meet goals and strategies
- Work independently but know when to elevate issues/barriers
- Ability to work Virtual Office or telecommute or both
- High school diploma or General Equivalency Diploma (G.E.D), and one (1) year of claims submission and claims processing experience.
- Bachelor's degree and/or prior experience working with AHCCCS and using PMMIS, and knowledge of Cognos or similar data processing software
* 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.
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)
* 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
* Opportunity to work 100% virtually or remotely on an ad-hoc basis (home office)
By providing the option of a full-time or part-time virtual/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.
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 email@example.com.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.