Benefits and Eligibility Specialist
Benefits and Eligibility Specialist
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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.
Benefits and Eligibility Specialist
Division of Member and Provider Services (DMPS)
Statewide Training Unit
Address: 801 E. Jefferson Street Phoenix AZ 85034
This position has the potential to work from a Virtual Office (VO) setting based on the unit needs and the performance of the individual.
Salary: $41693
Grade: 18
Closing Date: May 5 2025
Benefit & Eligibility Specialists (BESs) are responsible for making financial eligibility determinations for Medicaid programs. BESs provide customer service to diverse populations in a variety of settings that may include in person phone and/or call center.
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:
Completing financial eligibility determinations for ALTCS SSI MAO Medicare Savings KidsCare Specialty Medicaid and the FTW programs following productivity timeliness and quality guidelines. Scheduling and conducting interviews. Communicate with customers after the interview to include requesting information status updates and final decision.
Requesting eligibility verification from multiple sources and reviewing documentation in various systems.
Researching following and applying prescribed policies and procedures.
Documenting throughout the application process as needed actions taken relevant case information and eligibility related material in case records until final case determination is made using HEAplus system.
Participate in team meetings AMS Process improvement and assisting with special projects.
Knowledge:
A call center environment.
Medicare and Medicaid Programs.
State and Federal rules and statutes.
ALTCS SSI MAO Medicare Savings KidsCare Speciality Medicaid and the FTW financial eligibility policies and procedures.
Budget calculations used to determine eligibility.
Community resources.
Arizona Management System (AMS).
Skills:
Written and verbal communication.
Conducting research.
Investigative interviewing techniques.
Two way interaction and exchange of information with customers either face to face or over the phone.
Interpersonal relationships.
Problem solving and decision making.
Manage multiple tasks in a caseload.
Selfprioritize job functions as needed.
Mathematical calculations.
Phone etiquette.
Abilities:
Organize and prioritize a caseload.
Communicate both verbally and in writing.
Effectively document actions taken and decisions made.
Accurately calculate mathematical equations.
Apply current laws rules and regulations in making eligibility determinations.
Determine share of cost amounts.
Interview effectively when dealing with all community populations.
Apply customer service techniques; empathy active listening and remaining calm during customer interactions.
Efficiently interact with family members and other entities.
Effectively organize and prioritize tasks.
Use logic and problem solving techniques.
Analytical skills.
Use numerous computer databases systems and programs to include HEAplus PMMIS ACE FORTIS AZTEC RightFax Microsoft Google email and word processing applications.
Work with minimal supervision.
Work in an inbound automatic call distributor (ACD) environment.
Minimum: Must have a high school diploma or General Equivalency Diploma (G.E.D. and 6 months customer service related work experience. Must successfully pass a test appropriate to area of assignment. Chinle office only: Bilingual (fluent) in Navajo.
Preferred: 1 year customer service related work experience. Bilingual (Spanish) a plus but not required.
Successfully complete the Electronic Employment Eligibility Verification Program (EVerify) 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 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.
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 (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
