drjobs ALTCS Medical Appeals Specialist

ALTCS Medical Appeals Specialist

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1 Vacancy
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Job Location drjobs

Phoenix - USA

Monthly Salary drjobs

Not Disclosed

drjobs

Salary Not Disclosed

Vacancy

1 Vacancy

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 cost-effective 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 entry-level positions and internship opportunities AHCCCS offers meaningful career opportunities in a competitive industry.

Come join our dynamic and dedicated team.

ALTCS Medical Appeals Specialist

Division of Member and Provider Services (DMPS)

Job Location:

Address: 150 N. 18th Avenue Phoenix Arizona 85007

This position may offer the ability to work remotely within Arizona based upon the departments business needs and continual meeting of expected performance measures.

Posting Details:

Salary: $55000

Grade: 21

FLSA Status: Non-Exempt

First Review of Resumes: September 16 2025

Job Summary:

This position will be the units dedicated PAS expert to provide knowledge and support throughout the entire pre and post hearing processes on Medicaid eligibility in support of the Division of Member and Provider Services (DMPS) position.

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.

Job Duties:

Major duties and responsibilities include but are not limited to:
Regarding medical evidence gathered: Assist in the preparation of the agencys case for hearing; select evidence; gather legal authority; prepare agency witnesses. Provide guidance coaching and direction to eligibility staff responsible for conducting research and representing the agency at eligibility hearings.
Assist in presenting the agencys case with regards to medical information to the Administrative Law Judge including preparing the questioning of agency witnesses; testifying; cross examining complainants witnesses; objecting to irrelevant evidence or testimony; presenting closing remarks.
Coordinate agency actions to avoid hearings when applicable; monitor agency actions based on Directors Decisions regarding the hearings; update the Hearing Chapter in the Eligibility Policy Manual; develop or modifies hearing procedures as necessary (new programs changes in policy or procedures).
Participate in team and division meetings. Champion Arizona Management System (AMS) related to the ALTCS medical eligibility process and targets provide guidance insight and support to the AMS goals at the administrative regional office and operational levels.
Assists with the medical evidence and language in legal documents such Post Hearing Memorandum and legal motions; assists in the creation of agency responses to the Administrative Law Judge.
Provide consultation to management training and PAS Assessors; train individuals and group to agency staff on the appeals process for PAS Assessments.

Knowledge Skills & Abilities (KSAs):

Knowledge of:
An understanding of Federal and State laws and regulations governing the Medicaid programs
An understanding of the medical eligibility requirements and the process and procedures of PAS assessments.
State hearing procedures; rules of evidence; Office of Administrative Legal Services policies and procedures.
Analytical reasoning: how to build a convincing case based on facts and legal references.
AHCCCS policies.
ICD-10 codes.
Prescription drugs and uses.
Project development organization and prioritizing.

Skilled in:
Determining Medicaid eligibility using either medical eligibility criteria.
Negotiations and logical arguments.
Organization: Materials thoughts work and assignments.
Communicating with clarity and effectiveness by writing speaking and interpersonally interacting with others.

Ability to:
Prioritize and effectively manage tasks and arguments. Meet deadlines and specified goals using discretion and good judgment
Research medical evidence and present evidence in a logical manner using layman terms.
Interpret policy and apply it to a specific situation

Selective Preference(s):

Arizona Drivers License

Minimum: One year experience as a PAS Assessor or equivalent OR four years of experience providing social service case management that included individual planning and delivery of health care services.

Preferred: One to two years experience in Medicaid rules PAS Assessor Medical case management with the elderly physically disabled or developmentally disabled populations.

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 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 R.12.)

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 (E-Verify).

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. Learn more about the Paid Parental Leave pilot program here.
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.

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


Required Experience:

Unclear Seniority

Employment Type

Full-Time

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