Eligibility Appeals Specialist Jobs

Eligibility Appeals Specialist
519884
VARIOUS-STATEWIDE
AHCCCS
Full-time
AHCCCS
Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork
The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s 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.
Eligibility Appeals Specialist
Division of Member and Provider Services (DMPS)
Job Location:
This is a Statewide recruitment for various office locations within Arizona.
This position may offer the ability to work remotely within Arizona based upon the department's needs and continual meeting of expected performance measures.
Posting Details:
Salary: $46,000
Grade: 20
Apply By: 8/14/2023
Job Summary:
This Recruitment is for AHCCCS Employees Only
The Division of Member and Provider Services (DMPS) is looking for a highly motivated individual to join our team as an Eligibility Appeals Specialist as a (Grade 20) with the Office of Policy, Training & Appeals (OPTA). This position is responsible for reviewing appealed adverse actions, completing pre-hearing discussions, fair hearing packets and representing the agency at fair hearing. Research and interpret Federal and State laws, rules, related hearings or court decisions; ensures that appropriate authorities are included in the hearing packet; explains eligibility criteria to customers; works with the eligibility offices to prepare for fair hearings and assists in resolving matters prior to being set to calendar. They also process appropriate actions, to include initial and renewal determinations, in the eligibility system. They prepare motions, objections to motions and rehearing requests. Maintains the OMS Hearing Calendar and May be required to participate as part of a continuous process improvement team member or assist with a special project.
Major duties and responsibilities include but are not limited to:

• Assists in the maintenance and monitoring of the OMS Hearing Calendar; making initial and renewal eligibility determinations for MA-SP, Medicaid and AL TCS; entering eligibility data into the computer systems and information into hearing log.
• Reviewing adverse actions that are being appealed; investigating each case to identify if the decision is correct and making every attempt to resolve the eligibility problem to avoid a fair hearing; completing pre-hearing discussions and fair hearing packets; presenting of packets to the Office of Administrative Hearings (OAH) and to the Complainant within specified timeframes.
• Preparing motions necessary for vacates, continuances, and consolidations; preparing
• Accurately interpreting and application of MA-SP, Medicaid, and AL TCS laws, rules, regulations required to determine eligibility.
• Representing the agency at fair hearing and present explanation of agency's action and all relevant evidence and testimony; taking appropriate actions in the eligibility system regarding based on hearing decision.

Knowledge, Skills & Abilities (KSAs):
Knowledge:

• ALTCS and MA-SP financial eligibility policies and procedures
• State and Federal rules and regulations
• Medicare and Medicaid Laws
• Budget calculations based upon the program to which the recipient is linked
• Numerous computer data bases and programs to include ACE, HEAplus, PMMIS, Fortis, AZTEC and Rightfax

Skills:

• Written and verbal communication
• Conducting research
• Investigative interviewing
• Interviewing techniques

Abilities:

• Effectively document observations and decisions
• Use logic, problem solving techniques, and analytical skills
• Accurately calculate mathematical equations

Qualifications:
Arizona Driver’s License.
Minimum:

• Must have a high school diploma or General Equivalency Diploma (G.E.D) and 3 years of customer service experience.

Preferred:

• Two years of work experience equivalent to a Benefit & Eligibility Specialist or Program Services Evaluator (e.g., interviews and determines eligibility for public assistance benefits).

Pre-Employment Requirements:

• Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
• 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.
• 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.

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: Driver’s License Requirements.
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
• A top-ranked retirement program with lifetime pension benefits
• A variety of learning and career development opportunities
• Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
• RideShare and Public Transit Subsidy
• A robust and affordable insurance plan, including medical, dental, life, and disability insurance
• Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)

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.
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
Retirement:
Lifetime Pension Benefit Program

• Defined benefit plan that provides for life-long income upon retirement.
• Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
• Administered through the Arizona State Retirement System (ASRS)
• Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program

• Tax-deferred retirement investments through payroll deductions.
• Program administered through Nationwide.
• Voluntary participation.

Contact Us:
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing [email protected].
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.
Application Instructions
Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!