Provider Services Call Center Representative

Job Title

Provider Services Call Center Representative

Job Location

REMOTE OPTIONS, VARIOUS-STATEWIDE

Job Overview

The Provider Services Call Center Representative position is part of the Division of Member and Provider Services (DMPS) Office of Communication Advocacy, Resolution and Enrollment. As a representative, you will be responsible for 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.

Compensation

• Salary: $36,608
• Grade: 16

Responsibilities

• Answer calls received by the DMPS Provider Services 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 utilizing computer information systems to resolve complex customer concerns
• Contact health plans or pharmacies to immediately resolve issues of 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
• Analyze and research requests while ensuring quality
• Verify information and update systems accordingly
• Prepare documents for research and coordinate resolution of issues if necessary
• Handle all the operations required to support our members 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 which include: HEAplus, PMMIS, Medicare, APEP, SMIB/HIB, as well as other eligibility systems
• 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 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

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 update system data accurately
• Meet deadlines and specified goals using discretion and good judgment

Qualifications:

• Minimum:
  • Two years of experience in a multifunctional 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 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.

We're excited for you to apply!