Program Project Specialist 1

1 month ago

Phoenix, United States Arizona Official Website of State of Arizona Full time

Job Summary:

The Division of Fee For Service Management (DFSM) is looking for a highly motivated individual to join our team as an Program Project Specialist 1 . Under the direction of the Provider Network Manager, this position will assist with claims projects and claims testing responsibilities, along with providing technical support to internal and external customers regarding claims policies and procedures.

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)
Meets with provider organizations to interpret and explain billing rules, regulations and functions. Composes professional correspondence to provider organizations and stakeholders on claims issues.
Performs complex administrative & research tasks as well as special projects for the Provider Network Manager. Represents the Provider Network Manager at meetings, workshops & seminars. 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.
Participates in continual training to ensure current understanding of AHCCCS/DFSM/Claims Policies and Procedures.
Recommends, develops, and modifies claims procedures and forms to improve billing effectiveness. Knowledge, Skills & Abilities (KSAs):

Knowledge of:

Medical terminology.
Claims processing.
Research methodology.
AHCCCS Polices and Procedures.
AHCCCS Fee for Service reimbursement polices.

Skills in:

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.

Ability to:

Coordinate and work with others as needed.
Effectively communicate complex information in a clear and concise way.
Effective verbal and written communication.
Prioritize frequently during the day to meet goals and strategies.
Work independently but know wen to elevate issues/barriers.
Ability to work Virtual Office or telecommute or both. Qualifications:

Minimum Qualification:

High school diploma or General Equivalency Diploma (G.E.D)
One year of claims submission and claims processing experience.


Preferred Qualification:

Bachelor's degree and/or prior experience working with AHCCCS and using Prepaid Medical Management Information System (PMMIS), and knowledge of Cognos or similar data processing software. 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 may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code .) 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 (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
• Other Leaves - Bereavement, civic duty, and military.
• 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

Learn more about the Paid Parental Leave pilot program . For a complete list of benefits provided by The State of Arizona, please visit our

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.

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