PROGRAM PROJECT SPECIALIST 1
About The Position
The Department of Economic Security (DES) is seeking experienced and highly motivated individuals to join their team as a Program Project Specialist 1. DDD provides individuals with developmental disabilities, and their families, services and supports that are flexible, high quality, and member driven. These services provide individuals with opportunities to exercise their rights and responsibilities of independent decision-making and engagement in the community. Applicants for this position cannot be licensed or certified by the DDD Office of Licensing Certification and Regulation, cannot have a principal interest in or have a spouse or close family with principal interest in a DDD Qualified Vendor Agreement, and cannot be employed or subcontracted by a DDD Qualified Vendor.
Requirements
- Principles and practices of accounting.
- Federal and State laws, AHCCCS rules and regulations as applied to processing medical claims.
- Diagnostic, procedural coding and terminology used on medical claims.
- Computerized products used in accounting systems and processes; Case management principles as applied to development of individuals with disabilities.
- Complex math; Understanding of Reinsurance, Coordination of Benefits, Third Party Liability, and Medical Claims.
- Professional and comprehensive oral and written communication.
- Excellent Customer Services; Critical thinking ; Problem solving.
- Analytical analysis and research for independent decision making.
- Auditing ; Organizational skills for utilizing multiple resources to complete tasks.
- Moderate computer skills in Google Suites as well as multiple databases used by the Division.
- General computer skills such as typing and ten key; Interpersonal relationships.
- Analyze various often complex insurance documentation; Ability to work in multiple systems to complete tasks.
- Analyze billing problems and recommend viable solutions; Understanding customer needs; Identifying problems.
- Diffuse and resolve complicated issues while maintaining professional relationships.
- Provide training to diverse backgrounds; Analyze and evaluate data in order to assign to proper routes.
- Learn, interpret and apply Federal and State laws rules and regulations as they pertain to the assigned programs in the Division.
- Learn multiple processing systems; Measure results, meet productivity and quality standards.
Nice To Haves
- Experience with medical claims processing, TPL, coordination of benefits, reinsurance, and medical coding.
Responsibilities
- Manually process Coordination Of Benefits Waiver (COBW) request for complex medical claims. Analyze and research individual requests with unique coordination of benefit documentation provided by the TPL carrier. Determine if documentation is sufficient or if additional documentation is necessary. If necessary, direct contact to TPL(s) for verification prior to making informed decisions. Meet Deliverable timeliness requirements.
- Manually review and validate TPL verifications for eligibility using multiple sources including but not limited to varied databases, IVR, and verbal confirmations. Document, add or amend multiple databases, as necessary while maintaining Deliverable timeliness requirements. Review and respond to provider inquiries.
- Process and document complex reinsurance requests for all specialty reinsurance lines (including but not limited to Reinsurance, Catastrophic Reinsurance, Biologic, Hemophilia, and Transplants). Prepare documentation for other units (including but not limited to Finance, Medical Management, and MIS). Maintain timeliness for AHCCCS Deliverables. Work closely with sub-contracted acute plans to ensure they process encounters timely for reimbursement.
- Compile documentation to generate reports. Updates standard operating procedures. Attends trainings and meetings. Assists with special projects, as necessary.
Benefits
- Affordable medical, dental, life, and short-term disability insurance plans
- Participation in the Arizona State Retirement System (ASRS) and long-term disability plans
- 10 paid holidays per year
- Paid vacation and sick time
- Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child.
- Deferred compensation plan
- Wellness plans
- Tuition Reimbursement
- Stipend Opportunities
- Infant at Work Program
- Rideshare and Public Transit Subsidy
- Career Advancement & Employee Development Opportunities
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
