AHCCCS

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.

Provider Relations Specialist

Division of Fee For Service Management (DFSM)

 

Job Location:

Address:  801 E. Jefferson Street, Phoenix, AZ 85034

This position has the potential to work from a virtual office (VO) setting or may telecommute based on the needs of the unit and the discretion of leadership. 

Posting Details:

Salary:  $41,610 - $44,012

Grade: 18

Closing Date: Open Until Filled

Job Summary:

The Division of Fee For Service Management (DFSM) is looking for a highly motivated individual to join our team as a Provider Relations Specialist. 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