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Role Description

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.

• 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.

Qualifications

• Inbound call center experience.
• Arizona Medicaid programs; ALTCS, 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.

Requirements

• 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.

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