Tucson Benefits Eligibility Manager

Arizona Department of Administration • Tucson, AZ

3d • Remote

About The Position

This position supervises and manages a staff of medical eligibility specialist,
financial eligibility specialist, and supervisors who are responsible for
determining the eligibility of potential and continuing members who work with
the administration of the Arizona Long Term Care (ALTCS), Medicare Savings
Programs (MSP) and Medical Assistance - Specialty Programs (MA-SP). Position
monitors reports; timely actions; oversees case completion; monitors and
evaluates job performance; consults with management and supervisory staff to
provide technical assistance; and assists the Regional Manager with office
functions.

The State of Arizona strives for a work culture that affords employees
flexibility, autonomy, and trust. Across our many agencies, boards, and
commissions, many State employees participate in the State’s Remote Work Program
and are able to work remotely in their homes, in offices, and in hoteling
spaces. All work, including remote work, should be performed within Arizona
unless an exception is properly authorized in advance.

Major duties and responsibilities include but are not limited to:
• Ensuring that uniform interpretations and application of State and Federal
laws, agency policies and rules and regulations governing ALTCS, MSP and MA-SP
programs and other related program activities are maintained. Resolving
escalated issues and making referrals as appropriate.
• Monitoring the timeliness of eligibility determinations. Updating and
utilizing reports to ensure determinations are made within 45 days. Following up
with staff on cases approaching or exceeding the due date. Being proactive by
ensuring timely determinations are made.
• Monitoring the quality of eligibility determinations. Completing
pre-disposition QA reviews as needed. Following up with staff on QA findings.
Developing corrective action plans in response to QA findings and being
proactive by ensuring consistent quality determinations are made.
• Manage and develop financial and medical staff and supervisors. Conducting
regular unit meetings to ensure information is given to staff in a timely
manner; attending staff meetings. Holding weekly meetings to review pending
reports. Meeting no less than monthly with direct reports for performance
conferences.
• Champion AMS in Eligibility Operations and provide guidance, insight and
support to the lag and lead goals at the administrative and operational levels.
Mentor supervisors to develop an operationally efficient and highly performing
engaged workforce. Creating and maintaining an atmosphere in support of
division/ agency vision and culture resulting in high morale and employee
involvement.
• Works with office logistics along with ordering and assigning computers, phone
and other technology for employees.
• Participating in problem solving and/or planning work groups. Conducting
orientation and on the job training for staff.

Requirements

• ALTCS Medical and Financial eligibility and MSP and MA-SP Federal and State rules, regulations, policies and procedures
• AHCCCS philosophy, goals and objectives
• Tasks and functions performed by ALTCS and MA-SP supervisors, financial and medical eligibility staff
• Quality Assurance (QA) process and how findings relate to the specific functions performed by staff
• Systems: Health-e-Arizona Plus, AHCCCS Prepaid Medical Management Information System (PMMIS), Docuwear and Rightfax
• Cause and effect relationship between problems and solutions
• Functions of other divisions and administrations and how their work affects the operations of MSP, MA-SP and ALTCS
• Personnel rules, policies and procedures
• Leadership styles and practices
• Call center operations
• Arizona Management System (AMS)
• Establishing and maintaining effective working relationships with professional subordinates while evaluating their work and recommending changes
• Communicating effectively verbally and in writing with staff members of varied backgrounds and at different skill and experience levels
• Strong interpersonal skills to effectively manage staff and interact with program contractors, health plans and AHCCCS members
• Organizational skills for prioritizing, scheduling, coordinating and implementing workload
• Strong management and leadership
• Data collection, and analyzing information and processes
• Interviewing techniques, both financial and medical
• Interpret, analyze and apply current laws, rules, regulations and policies
• Direct subordinates and determine work assignments
• Communicate effectively, both orally and in writing
• Type and use a personal computer/laptop and other computer programs
• Travel and stay overnight as needed
• Handle facility and systems issues
• Arizona Driver's License
• Two years of supervisory level experience or three years of professional experience related to health programs appropriate to the assignment including program planning and administration may substitute for the experience supervision; a Master's degree in a field appropriate to the assignment may substitute for one year of the required technical experience.

Nice To Haves

• Two years of supervisory level experience performing eligibility (Financial) work or two years’ experience performing medical eligibility work (PAS Assessor). Experience related to health programs in Aging, Developmental/Physical Disabilities or Mental Health, which include program planning or administration.

Responsibilities

• Ensuring that uniform interpretations and application of State and Federal laws, agency policies and rules and regulations governing ALTCS, MSP and MA-SP programs and other related program activities are maintained. Resolving escalated issues and making referrals as appropriate.
• Monitoring the timeliness of eligibility determinations. Updating and utilizing reports to ensure determinations are made within 45 days. Following up with staff on cases approaching or exceeding the due date. Being proactive by ensuring timely determinations are made.
• Monitoring the quality of eligibility determinations. Completing pre-disposition QA reviews as needed. Following up with staff on QA findings. Developing corrective action plans in response to QA findings and being proactive by ensuring consistent quality determinations are made.
• Manage and develop financial and medical staff and supervisors. Conducting regular unit meetings to ensure information is given to staff in a timely manner; attending staff meetings. Holding weekly meetings to review pending reports. Meeting no less than monthly with direct reports for performance conferences.
• Champion AMS in Eligibility Operations and provide guidance, insight and support to the lag and lead goals at the administrative and operational levels. Mentor supervisors to develop an operationally efficient and highly performing engaged workforce. Creating and maintaining an atmosphere in support of division/ agency vision and culture resulting in high morale and employee involvement.
• Works with office logistics along with ordering and assigning computers, phone and other technology for employees.
• Participating in problem solving and/or planning work groups. Conducting orientation and on the job training for staff.

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: Manager
• Number of Employees: 501-1,000 employees