Arizona Health Care Cost Containment System (AHCCCS)
Phoenix, Arizona, United States
Title: Health Program Manager 3
Job Description
- 524719
- PHOENIX
- REMOTE OPTIONS
- AHCCCS
- Full-time
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork
The Arizona Health Care Cost Containment System (AHCCCS), Arizonas 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 has the potential to work from a virtual office (VO) setting or may telecommute based on the needs of the unit and at the discretion of leadership.
Posting Details:
Grade: 22
Closing Date: Open Until Filled
The Division of Fee For Service Management (DFSM) is looking for a highly motivated individual to join our team as an Health Program Manager 3. Under the direction of the Claims Operational Administrator, this position is responsible for conducting the majority of prepayment reviews on behavioral health claims in PMMIS, and serve the Division of Fee for Service Management (DFSM) as a subject matter expert to behavioral health services. The Behavioral Health Consultant will collaborate with DFSM units on behavioral health service policy revisions, guidelines and procedures.
Major duties and responsibilities include, but are not limited to:
* Conducts prepayment reviews on behavioral health claims in the Prepaid Medical Management Information System (PMMIS). Serves as the behavioral health prepayment expert and point of contact for complex inquiries.
* Develops standard work procedures (desk levels) for other positions on how to conduct prepayment review for behavioral health related claims. May offer consultation to other units for best practices related to behavioral health services.
* Contributes and serves as the subject matter expert to policy revisions related to behavioral health services for the Division of Fee-for-Service Management (DFSM).
* Conducts virtual training and technical assistance related to clinical aspects of behavioral health services and documentation with provider organizations.
* Meets with behavioral health provider organizations to provide feedback on claims, documents, prior authorizations, and training. At times, will collaborate with the Provider Network manager on behavioral health related service tickets.
* Develops and conducts virtual training related to AHCCCS policies on behavioral health services for and alongside the Education team.
* When needed, attends, conducts, and consults with site visit reviews.
Knowledge of:
* Principles and practices of supervision and staff development.
* Principles and practices in behavioral health services.
* AHCCCS, ALTCS, Medicaid and Medicare Regulations.
* State Statute and Rule and Policies applicable to AHCCCS Programs, AHCCCS Policies and Procedures.
* Fundamentals of IHS/638 claims processing and billing.
* Familiarity AHCCCS' Information Management System, Prepaid Medical Management Information System (PMMIS).
Skills in:
* Excellent problem solving skills.
* Proficient in Microsoft and Google Suite, etc.
* Excellent customer service and training skills.
* Project management of multiple assignments.
* Analyze and effectively recommend resolution to provider issues.
Ability to:
* Cross-train in all areas of DFSM claims department.
* Communicate effectively and clearly verbally and in writing.
* Read and understand medical records.
* Understand medical terminology.
* Work independently with minimal direction.
* Interpret rules and regulations, policies, and procedures as it related to the program.
* Work Virtual Office or Telecommute or both.
Possession of a current Arizona Drivers License.
Minimum Qualifications:
* Four years experience in behavioral health in Arizona.
* Masters Degree in Behavioral Health related field may substitute for one year of require experience.
Preferred Qualifications:
* Professional license
* 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 agencys 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.
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.
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
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.
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.