Title: Provider Relations Manager

• 525096

• PHOENIX
• REMOTE OPTIONS
• VARIOUS-STATEWIDE

• AHCCCS

• Full-time

Under the direction of the Claims Operational Administrator, this position is responsible for overseeing the provider network team and ensuring timely and accurate responses to provider services tickets related to the Division of Fee-for-Service Management (DFSM) claims and/or prior authorization. The Provider Network Manager is the main point of contact for in-depth meetings related to DFSM claims and/or prior authorization concerns, inquiries, and/or escalations.

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.

Major duties and responsibilities include but are not limited to:
* Leads and oversees the Provider Network team who respond to Services Tickets submitted by provider organizations to the Division of Fee-for-Service Management (DFSM). Provides training and support to staff in responding to claims and prior authorization service tickets.
* Leads and attends meetings as requested with provider organizations to answer questions and identify issues. Works with providers to resolve claims and/or prior authorization issues.
* Tracks data related to service tickets and reports back to leadership. Ensures timely and accurate responses to provider services tickets.
* Facilitates the Joint Operations Committee (JOC) Meetings with provider organizations. Takes notes and records discussion items in the JOCs.
* Works collaboratively with Division of Business & Finance (DBF), Information Systems Division (ISD), provider enrollment, and member services to ensure provider needs are met and solve complex problems.
* Works closely wit the Adjudication unit to identify and resolve claims system problems. Makes DFSM leadership aware of findings.
* Makes referrals to the Office of Inspector General (OIG) for suspected Fraud, Waste, and Abuse.
* Responds to escalated inquiries from the executive leadership team.

Knowledge:
* Principles and practices of supervision and staff development
* Principles and practices of provider network relations
* 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:
* Excellent problem solving skills
* Proficient in Microsoft and Google Suite, etc.
* Excellent customer service skills
* Project management of multiple assignments
* Analyze and effectively recommend resolution to provider issues

Abilities:
* 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

Arizona State Drivers License

Minimum:
* Four years professional experience related to health programs appropriate to the assignment, which includes experience in Healthcare Administration AND Two plus years of managerial experience. Experience with medical claims and coding, Arizona Medicaid, and medical records.

Preferred:
* Bachelors or Masters Degree in Healthcare Administration or in related field. Experience in both behavioral health administration and medical services administration. Certified coder. Familiarity with PMMIS, Cognos, and/or AHCCCS policies.

* 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.

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: Drivers License Requirements.

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

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

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.