Operations Compliance Officer

Arizona Department of Administration • Phoenix, AZ

2d

About The Position

The position is responsible, along with a team of individuals in the Operations
Unit, for having a comprehensive understanding of federal and state regulation
guiding the provision of managed care and for ensuring that all AHCCCS managed
care organizations/contractors adhere to all applicable regulations as well as
all requirements outlined in contract and in AHCCCS policy.

Major duties and responsibilities include but are not limited to:
• Represent AHCCCS at meetings with contractors and other contractor
professionals; participate in special projects related to Medicaid managed care,
including rules teams, fraud prevention, contract development, audits,
compliance reviews etc.
• Monitor, evaluate and prepare responses, as applicable, for contractor
deliverables and/or conduct provider network availability/accessibility
monitoring.
• Organize and coordinate services and communication among AHCCCS divisions and
contractors for the purpose of identifying, resolving, and monitoring contractor
compliance issues.
• Interpret various administrative rules, regulations, policies, and procedures.
• Prepare responses to contractors, state agencies, and others requesting
technical assistance or expressing a concern or complaint related to the acute,
integrated physical and behavioral health, and long-term care programs.
• Provide technical assistance to contractors, providers, members, and other
internal and external customers.
• Monitor and evaluate the development of new contractors who successfully bid
for acute, integrated physical and behavioral health, and long-term care
services.
• Produce written policies, procedures and reports for the acute, integrated
physical and behavioral health and long-term care programs.

Requirements

• Two (2) to three (3) years of experience in Medicaid service delivery (acute, long-term care and/or behavioral health services).

Nice To Haves

• Bachelor's or higher degree in Public Health, Social Work or Public Administration or closely related field.

Responsibilities

• Represent AHCCCS at meetings with contractors and other contractor professionals; participate in special projects related to Medicaid managed care, including rules teams, fraud prevention, contract development, audits, compliance reviews etc.
• Monitor, evaluate and prepare responses, as applicable, for contractor deliverables and/or conduct provider network availability/accessibility monitoring.
• Organize and coordinate services and communication among AHCCCS divisions and contractors for the purpose of identifying, resolving, and monitoring contractor compliance issues.
• Interpret various administrative rules, regulations, policies, and procedures.
• Prepare responses to contractors, state agencies, and others requesting technical assistance or expressing a concern or complaint related to the acute, integrated physical and behavioral health, and long-term care programs.
• Provide technical assistance to contractors, providers, members, and other internal and external customers.
• Monitor and evaluate the development of new contractors who successfully bid for acute, integrated physical and behavioral health, and long-term care services.
• Produce written policies, procedures and reports for the acute, integrated physical and behavioral health and long-term care programs.

Benefits

• 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.
• 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

What This Job Offers

• Job Type: Full-time
• Number of Employees: 501-1,000 employees