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.

Customer Service Representative 3

DMPS - Division of Member and Provider Services

Job Location:

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

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

Must reside in the State of Arizona.

Posting Details:

Salary: $36,608 

Grade: 16

Closing Date: Open Until Filled

Job Summary:

This position is part of DMPS Office of Communication Advocacy, Resolution and Enrollment’s (OCARE) specialized units dedicated to serving the Office of the Client Advocate (OCA) Community Partners, Special Accommodations and/or Provider Services by resolving problems and responding to inquiries and concerns from high level sources within AHCCCS, AHCCCS providers, state and local government entities, members, general public, and community partner organizations.

Job Duties:

Major duties and responsibilities include, but are not limited to:
• Answer calls received by the DMPS OCA, Provider Services, Community Partners and Special Accommodations units; resolve high level inquiries from the Governor's office, legislature, and Senior AHCCCS leadership; adhere to established call center guidelines and agency policies.
• Researching and analyzing difficult case discrepancies utilizing computer information systems to resolve complex customer concerns, questions and offer resources. Contacting health plans or pharmacies to immediately resolve issues of urgent medical needs. Technical assistance to providers and agency staff regarding billing procedures, reimbursement policies, prior authorization requirements and eligibility information.
• Processing of all types of case actions. Monitor and assist with processing requests. Discuss projects, clarify information, resolve problems, and exchange information at all levels. Analyzing and researching requests while ensuring quality.
• Verify information and update systems accordingly, if necessary, with accurate information and other pertinent data. Prepares documents for research and coordinates resolution of issues if necessary.
• Handling of all of the operations required to support our members and the general public. Provide virtual and in-house support.
• Completion of monthly, quarterly, and on-demand statistical reporting as requested.
• Actively participate in the Arizona Management System initiative within the unit, division, and agency. Actively participate in OCARE meetings and activities.

Knowledge, Skills & Abilities (KSAs):

Knowledge:
• Inbound call center experience.
• Arizona Medicaid programs; AL TCS, SSA, DES and other eligibility programs and systems.
• Codes, values, logic, and system processes which include: HEAplus, PMMIS, Medicare, APEP, SMIB/HIB, as well as other eligibility systems.
• Handling complex types of problems and reports within each of these systems.
• AHCCCS policies and procedures for all categories and programs regarding eligibility and enrollment.
• Arizona Management System and standard lean practices.

Skills:
• Working independently and taking initiative.
• Exceptional technical, analytical, problem solving and decision-making.
• Interpreting and utilizing complex rules and procedures.
• Effective and tactful communication which includes wri