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 Division of Member and Provider Services Job Location: Address: 801 E. Jefferson Street, Phoenix, AZ 85034 This position has the potential to work in a Virtual Office/Telecommute setting based on the unit needs and the individual meeting agency requirements. 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 Partner Assistor Organization 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. 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. Job Duties: Major duties and responsibilities include but are not limited to: * Answer calls received by the DMPS OCA, Provider Services, Community Partners Assistor Organization, 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 calls, 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 writing, one- on-one contact, public speaking, listening, and providing feedback. * Numerous computer systems, databases, and programs to include HEAplus, PMMIS, Docuware, Prior Authorization Internal, InvGate, APEP, RightFax, Microsoft, Google, email, word processing and spreadsheet applications. * Organizing materials, thoughts and prioritizing work and assignments effectively. * Strong interpersonal skills and customer service techniques. Abilities: * Handle consistent incoming workload and special projects quickly and accurately. * Exercise tact and maintain positive interpersonal interactions. * Quickly grasp changes and new policy, procedures, and rules. * Understand multiple subsystems and to update system data accurately. * Meet deadlines and specified goals using discretion and good judgment. Selective Preference(s): Minimum: Two years of Experience in a multi-functional customer service environment. Preferred: Experience working in medical eligibility, enrollment, claims processing, or claims customer service. Bilingual (Spanish) a plus. Pre-Employment Requirements: * Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees. * 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.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed. If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver's License Requirements. All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify). Benefits: Among the many benefits of a career with the State of Arizona, there are: * 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 By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion. Learn more about the Paid Parental Leave pilot program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page Retirement: Lifetime Pension Benefit Program * Administered through the Arizona State Retirement System (ASRS) * Defined benefit plan that provides for life-long income upon retirement. * Required participation for Long-Term Disability (LTD) and ASRS Retirement plan. * Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period). Deferred Retirement Compensation Program * Voluntary participation. * Program administered through Nationwide. * Tax-deferred retirement investments through payroll deductions. Contact Us: Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov. Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.