Job Description

Quality Assurance Reviewer

  • 508337
  • REMOTE OPTIONS
  • VARIOUS-STATEWIDE
  • AHCCCS
  • Full-time

AHCCCS

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.

Quality Assurance Reviewer

Job Location:

Address: VARIOUS/STATEWIDE

This position may offer the ability to work remotely within Arizona based upon the department's needs and continual meeting of expected performance measures.

Posting Details:

Salary: $36,602

Grade: 18

Open until filled: 1st review of resumes on (6/01/22)

Job Summary:

OPEN TO AHCCCS EMPLOYEES ONLY

The Division of Member & Provider Services (DMPS) is looking for a highly motivated individual to join our team as a Quality Assurance Reviewer with PS Office of Eligibility Compliance and Oversight (OECO). This position is responsible for completing quality assurance reviews of eligibility determinations for all programs. Reviews can be completed pre or post disposition. Major duties and responsibilities include but are not limited to:

* Verifies eligibility factors, performs routine inquires in all systems and researches policy manuals to support QA findings.

* Utilizes Employee Metrics for completing and reporting quality review outcomes.

* Responds to challenges of review findings and general questions in relation to QA findings.

* Maintains productivity logs to track status of reviews. Completes statistical reports as needed.

* Identifies error trends, training needs and suggests policy manual updates in an effort to improve the quality of eligibility determinations.

* Attends workshops and training sessions in efforts to support continuous learning and to stay current in policy and procedures.

* In support of the needs of the division, completes special projects and other duties as assigned.

* Fosters teamwork and collaborative efforts while providing continual internal & external customer service in support of agency & division missions and values.

* Due to COVID-19 precautions the recruiting process has been adjusted to meet the standard health guidelines outlined by the State. Interviews will be conducted virtually and may also be by way of video conference utilizing a platform like Google Meet/Hangouts or WebEx/Zoom.

Knowledge, Skills & Abilities (KSAs):

Knowledge:
* Federal and State laws and regulations governing SSI-MAO, MSP, Medicaid and ALTCS programs.
* AHCCCS Acute Care and ALTCS eligibility categories and financial eligibility policies and procedures.

Skills:
* Researching and interpreting Federal and State laws, statues, rules, regulations, policies, procedures and guidelines.
* Problem identification and resolution
* Assessing, reviewing and analyzing databases information

Ability:
* Work independently
* Document effectivity
* Perform basic mathematical calculations

Qualifications:

Minimum:
* Must possess a current and valid Arizona driver’s license.

Preferred:
* Two years of work experience equivalent to a Program Services Evaluator (e.g. interviews and determines eligibility for public assistance benefits).

Pre-Employment Requirements:

* 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 is 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.

Benefits:

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 (12 and 13 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

Retirement:

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.

Contact Us:

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. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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