Customer Service Representative 4
Customer Service Representative 4
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Job Description
AHCCCS
Arizona Health Care Cost Containment System
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 costeffective 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 entrylevel positions and internship opportunities AHCCCS offers meaningful career opportunities in a competitive industry.
Come join our dynamic and dedicated team.
Customer Service Representative 4
Division of Member and Provider Services (DMPS)
Address: 801 E. Jefferson Street Phoenix AZ 85034
This position may offer the ability to work remotely within Arizona based upon the departments business needs and continual meeting of expected performance measures.
Salary: $38499
Grade: 17
First Review of Resumes: March 17 2025
This position is responsible for conducting Provider Enrollment. OnSite Visits Provider facility compliance with CMS Medicaid facility requirements providing assistance guidance and answering questions. during 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.
The State of Arizona strives for a work culture that affords employees flexibility autonomy and trust. Across our many agencies boards and commissions many State employees participate in the States Remote Work Program and are able to work remotely in their homes in offices and in hoteling spaces. All work including remote work should be performed within Arizona unless an exception is properly authorized in advance.
Major duties and responsibilities include but are not limited to:
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.
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.
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.
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.
Act as an AMS Team Lead on projects and presentation of sections 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
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:
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 problemsolving 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 inperson or telephonic interviews
Arizona Drivers License
Minimum: Two and a half years of experience in a multifunctional customer service environment.
Preferred: Experience working in medical eligibility enrollment claims processing or claims customer service. Bilingual (Spanish) is a plus.
Successfully pass fingerprint background check prior employment verifications and reference checks; employment is contingent upon completion of the abovementioned 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 R210207.12. 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 (EVerify).
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 parttime employees)
Paid Parental LeaveUp to 12 weeks per year paid leave for newborn or newlyplaced foster/adopted child (pilot program).
Other Leaves Bereavement civic duty and military.
A topranked 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 fulltime or parttime 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 programhere. 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 lifelong income upon retirement.
Required participation for LongTerm Disability (LTD) and ASRS Retirement plan.
Pretaxed payroll contributions begin after a 27week waiting period (prior contributions may waive the waiting period).
Deferred Retirement Compensation Program
Voluntary participation.
Program administered through Nationwide.
Taxdeferred 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
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.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
