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.

Salary: $71032 - $72532

FLSA Status: Non-Exempt

Grade: 21

Closing Date: Open until filled

The Team Lead will ensure and provide direct oversight to each BH Clinical Review Team member to verify their clinical reviewer competencies in the following areas: Utilizing standard work procedures to complete clinical reviews of behavioral health records and claims. Meet on-going competencies and training metrics for accurate use of PMMIS/Claims Processing Software EDMS Service Now and Microsoft applications. Collaborate with PPR Program Manager and DFSM policy subject matter experts to assist reviewers with maintaining current knowledge of State Federal and AHCCCS laws policies and practices as applicable to behavioral PPR Program Manager with new hires of BH reviewers including but not limited to: pre-screening interviewing on-boarding and on-going training/clinical oversight.

Under the guidance of the Pre-Payment Review Program Manager the team lead will assist and co-facilitate internal team meetings and by-weekly individual oversight sessions. The team lead will assist with BH reviewer goal setting and on-going support to meet monthly/quarterly objectives including cross-training in various domains outside of the behavioral health clinical reviews.

The team lead will engage in on-going monitoring and support of BH reviewer work-related stressors clinical and technical challenges/questions and work to mitigate daily needs and concerns. The Team Lead will work closely with PPR Program Manager Claims Operations Manager and Clinical Consultants/SMEs to identify and resolve immediate or systemic complications associated with the BH clinical review processes.

Under the guidance of the Pre-Payment Review Program Manager the team lead will assist with behavioral health provider Technical/Clinical Assistance meetings that aim to support providers with their compliance of contractual regulatory and statutory obligations for Fee-for-Service (FFS) members. The Team Lead will assist with submissions of OIG referrals for suspected fraud waste and abuse. The Team Lead will assist with evaluating and monitoring trends in over and underutilization of covered services/codes billed. Contribute to evaluating and organizing claims and clinical information from multiple sources including utilization data case file reviews and formal clinical audits.

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:
Will assist to ensure each team member is performing to the highest level and accordance to the direction of the Prepayment Review Program Manager Claims Administrator and DFSM Leadership.
Meet with the Prepayment Review Program Manager and/or other team leads and/or supervisors to discuss overall unit objectives and individual staff metrics and to develop a fluid management plan that contains the action steps on how as a management team we can succeed on all assigned tasks and leaderships expectations.
Assist in facilitating assigned team meetings huddle boards and similar meetings. Encourage staff to participate in these meetings so innovative ideas can be discussed and implemented to improve overall team metrics.
Participate in the development and delivery of trainings relating to the improvement of the overall BH pre-payment claims review process audit and related areas.
Participate in internal and external meetings as requested and collaborate with other DFSM Claims staff to ensure full understanding of team and departmental work flows.
Become efficient in utilizing the Arizona Health Care Cost Containment System (AHCCCS) information system called Prepaid Medical Management Information System (PMMIS) in order to process pre-payment reviewed claims and have the ability to train staff on this integral system.

Knowledge:
Service Authorization concepts principles and strategies
Advanced knowledge of the behavioral health service delivery system and the needs of children and the needs of individuals designated as SMI
Principles of behavioral health management and assessment
Individual service planning process and substance abuse treatment
HCPCS codes Levels I & II and knowledge of International Classification of Diseases DSM IV/V coding and medical billing guidelines
Medical technology computer data retrieval and input including EHR HIE etc
Medicaid and Medicare Federal Regulations State Statute Rules and Policies applicable to AHCCCS programs
AHCCCS program design and implementation prior authorization functions and responsibilities provider network and funding source
Familiarity with American Indian Tribes programs and policy

Skills:
Problem solving identification evaluation and imitation of appropriate action and case management assessment
Excellent verbal/written communication skills with FFS Providers
Organizational skills to coordinate monitor and report on multiple cases simultaneously
Analytical skills to identify and correlate specific patterns initiate investigations submit findings and recommendations
Strong interpersonal skills in working with people of diverse cultures and socioeconomic backgrounds
Documentation research and reporting of data and trends
Strong computer skills including Microsoft and Google Suite

Abilities:
Strong ability to collaborate with others for mutually beneficial outcomes
Interpret clinical information and assess implications for treatment
Read interpret and apply complex rules and regulations
Independent decision making yet knowing when to elevate the decision
Drive long distances when required
Ability to work Telecommute

Arizona Drivers License

Minimum: Three or more years clinical and programmatic experience working with the behavioral health service delivery systems. Behavioral Health Professional (independent/associate license within AZ) Licensed Nurse and/or related licensed professional.

Preferred: Advanced experience in clinical and/or claims supportive documentation review and analysis.

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.

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 (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.

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 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).

Deferred Retirement Compensation Program
Voluntary participation.
Program administered through Nationwide.
Tax-deferred 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.