Title: Customer Service Representative 4

Customer Service Representative 4

Customer Service Representative 4

Division of Member and Provider Services (DMPS)

Job Summary:

This position is responsible for conducting Provider Enrollment, on-site visits, ensuring provider facility compliance with CMS Medicaid facility requirements, providing assistance, guidance, and answering questions during the enrollment/application process for AHCCCS Providers. Will assist Providers with application packets in person and over the phone. Interview and question providers to elicit information necessary to determine CMS criteria being met for applicant provider type.

Job Duties:

Major duties and responsibilities include but are not limited to:

1. Assisting AHCCCS Providers in processing their application, answering questions and collecting information. Assisting over 100 different provider types and knowledge of eligibility criteria for each provider type.
2. Site Visits, both individually and in a team of 2, depending on the scope of the visit and distance. Visits will determine the enrollment of services being provided by Provider. Determine that Services, Offices, and equipment are operable and match information provided on the application completed by Provider.
3. Determining eligibility of Provider based on CMS guidelines. Research provider demographics in PECOS, follow CMS audit process/guidelines regarding compliance of Medicare Debt and billing practices and encounters.
4. Assess risk level and in-depth screening of Providers to ensure excluded providers are eliminated from Medicaid Enrollment. Compile all documents for Provider disciplinary action for AHCCCS Medical Review board.
5. Act as an AMS Team Lead on projects and presentation of section's statistics. Share Assignment results with the team, suggest process flow changes. Interpret policy and procedure changes. Assist with training new staff by providing on-the-job training techniques and mentorship.
6. Studying statutes, rules, policy manuals and clarifications, attending training and conferring with supervisor and others to improve skills and maintain expert level of knowledge.

Knowledge, Skills & Abilities (KSAs):

Knowledge:
* Computer systems to include word processing, spreadsheet, email and database applications.
* Medicaid Programs and Prepaid Medical Management Information System (PMMIS) and/or PECOS.
* Expert knowledge of CMS State statute.
* Rules and regulation relating to the determination of eligibility to become an AHCCCS Provider.
* AHCCCS Provider Enrollment Portal, APEP.

Skills:
* Interpretation of written and verbal information.
* Troubleshooting and problem-solving skills, research methodologies.
* Independent working skills (requiring a minimum of supervision) interviewing techniques to elicit information effective verbal and written communication.
* Basic computer skills.
* Good communication skills when interacting with internal and external entities.
* Google and/or word processing, spreadsheet and database applications and proprietary healthcare computer systems such as APEP.

Abilities:
* Work within a team environment.
* Function effectively in an orderly and purposeful manner in situations of stress or tension.
* Work with the public in less than ideal conditions.
* Deal with multiple tasks at one time.
* Listen, comprehend and offer guidance to questions surrounding Medicaid enrollment through in-person or telephonic interviews.

Selective Preference(s):

Arizona Driver's License.
Minimum: Two and a half 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 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 (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.

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

Benefits:

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.

Retirement:

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).

Contact Us:

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.