Community Partner-Assistor Organization Call Center Representative

Job Title

Community Partner-Assistor Organization Call Center Representative

Job Location

• Address: This is a Statewide recruitment for various office locations within Arizona
• Remote Options: Available based on the department's needs and continual meeting of expected performance measures

Job Overview

The Arizona Health Care Cost Containment System (AHCCCS) is seeking a highly motivated individual to join our team as a Community Partner-Assistor Organization Call Center Representative. In this role, you will be part of the Division of Member and Provider Services' Office of Communication Advocacy, Resolution, and Enrollment. Your main responsibility will be to resolve inquiries and concerns from high-level sources within AHCCCS, AHCCCS providers, state and local government entities, members, general public, and community partner organizations.

Compensation

• Salary: $36,608
• Grade: 16

Responsibilities

• Answer calls received by the DMPS Community Partners- Assistor Organizations and Justice Enrollment units
• Resolve high-level inquiries from the Governor's office, legislature, and Senior AHCCCS leadership
• Adhere to established call center guidelines and agency policies
• Research and analyze difficult case discrepancies to resolve complex customer concerns and questions
• Contact health plans or pharmacies to immediately resolve urgent medical needs
• Provide technical assistance to providers and agency staff regarding billing procedures, reimbursement policies, prior authorization requirements, and eligibility information
• Process all types of case actions
• Monitor and assist with processing requests
• Discuss projects, clarify information, resolve problems, and exchange information at all levels
• Verify information and update systems accordingly if necessary
• Prepare documents for research and coordinate issue resolution if necessary
• Handle all the operations required to support members, assistors, providers, and the general public
• Provide virtual and in-house support
• Complete 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

Requirements

Knowledge:

• Inbound call center experience
• Arizona Medicaid programs; ALTCS, SSA, DES, and other eligibility programs and systems
• Codes, values, logic, and system processes (HEAplus, PMMIS, Medicare, APEP, SMIB/HIB, etc.)
• AHCCCS policies and procedures for all categories and programs regarding eligibility and enrollment

Skills:

• Working independently and taking initiative
• Exceptional technical, analytical, problem-solving, and decision-making skills
• Interpreting and utilizing complex rules and procedures
• Effective and tactful communication (writing, one-on-one contact, public speaking, listening, and providing feedback)
• Numerous computer systems, databases, and programs (HEAplus, PMMIS, Docuware, Prior Authorization Internal, InvGate, APEP, RightFax, Microsoft, Google, email, word processing, and spreadsheet applications)

Abilities:

• Handle consistent incoming workload and special projects quickly and accurately
• Exercise tact and maintain positive interpersonal interactions
• Quick grasp of changes and new policies, procedures, and rules
• Understand multiple subsystems and update system data accurately
• Meet deadlines and specified goals using discretion and good judgment

Qualifications:

• 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) is a plus

Pre-Employment Requirements:

• Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify)
• Successfully pass fingerprint background check, prior employment verifications, and reference checks
• Travel may be required for State business. Employees who drive on state business must complete any required driver training and have an acceptable driving record

We're excited for you to apply!