Provider Enrollment Customer Service Representative

Arizona Department of Administration • Phoenix, AZ

4d • $38,499 • Remote

About The Position

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. This position is responsible for conducting Provider Enrollment. On-Site Visits, Provider facility compliance with CMS Medicaid facility requirements, providing assistance, guidance, and answering questions during enrollment/application process for AHCCCS Providers. Will assist Providers with application packets in person and over the phone. Interview and question providers to elicit information necessary to determine CMS criteria being met for applicant provider type.

Requirements

• Computer systems to include word processing, spreadsheet, email and database applications.
• Medicaid Programs and Prepaid Medical Management Information System (PMMIS) and/or PECOS.
• Expert knowledge of CMS State statute
• Rules and regulation relating to the determination of eligibility to become an AHCCCS Provider
• AHCCCS Provider Enrollment Portal, APEP
• Interpretation of written and verbal information
• Troubleshooting and problem-solving skills, research methodologies
• Independent working skills (requiring a minimum of supervision) interviewing techniques to elicit information effective verbal and written communication
• Basic computer skills
• Good communication skills when interacting with internal and external entities
• Word processing, spreadsheet and database applications and proprietary healthcare computer systems such as APEP
• Work within a team environment
• Function effectively in an orderly and purposeful manner in situations of stress or tension
• Work with the public in less than ideal conditions
• Deal with multiple tasks at one time
• Listen, comprehend and offer guidance to questions surrounding Medicaid enrollment through in-person or telephonic interviews
• Two and a half years of experience in a multi-functional customer service environment.
• 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 R2-10-207.12.)
• All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

Nice To Haves

• Arizona Driver's License
• Experience working in medical eligibility, enrollment, claims processing or claims customer service.
• Bilingual (Spanish) is a plus.

Responsibilities

• Assisting AHCCCS Providers in processing their application, answering questions and collecting information. Assisting over 100 different provider types and knowledge of eligibility criteria for each provider type.
• Site Visits, both individually and in a team of 2, depending on the scope of the visit and distance. Visits will determine the enrollment of services being provided by Provider. Determine that Services, Offices, and equipment are operable and match information provided on the application completed by Provider.
• Determining eligibility of Provider based on CMS guidelines. Research provider demographics in PECOS, follow CMS audit process/guidelines regarding compliance of Medicare Debt and billing practices and encounters.
• Assess risk level and in depth screening of Providers to ensure excluded providers are eliminated from Medicaid Enrollment Compile all documents for Provider disciplinary action for AHCCCS Medical Review board.
• Act as an AMS Team Lead on projects and presentation of section's statistics. Share Assignment results with the team, suggest process flow changes. Interpret policy and procedure changes. Assist with training new staff by providing on the job training techniques, and mentorship
• Studying statutes, rules, policy manuals and clarifications. attending training and conferring with supervisor and others to improve skills and maintain expert level of knowledge.

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 (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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed