Quality assurance specialist [h1.location_city]

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.

Quality Assurance Specialist

Division of Fee for Service Management (DFSM)

Job Location :

Address : 150 North 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 : $47999

FLSA Status : Non-Exempt

Grade : 19

Closing Date : Open Until Filled

Job Summary :

Under the direction of the DFSM Quality Assurance (QA) Manager this position serves as the coordinator for DFSM QA activity and deliverable tracking and develop infrastructure for QA activities including developing and maintaining desk levels process and dataflows coordinating internal and external meetings and follow up develops spreadsheets reports etc. track deadlines receipts reviews and responses associated with QA deliverables maintain confidential files tracks and maintains the units leave schedules. This position has in-office duties to address member and provider communication outreach and support the unit during site visits based on the unit and divisional needs.

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 :

Provide support to the CMSU CM team functions including care management & care coordination support functions such as monitoring processing & distribution of care management referrals outreach documentation & follow up as directed managing the Transition of Care ETI folder CRS referrals provider or member outreach & documentation & follow up as directed. Coordinates amongst the DFSM QA team OOD QM OIG OGC and other stakeholders including TRBHAs.

Develops desk levels spreadsheets reports and draft communications for the unit as requested. Maintain hard and / or electronic copies of files including but not limited to desk levels and process / data flow charts. Completes and maintains documentation of archived records / files. Sends external correspondence tracks timelines for requests and responses.

Schedule and provide unit support for internal and external meetings by preparing and distributing meeting materials and taking meeting minutes coordinate follow-up from discussions and track resulting deliverables and agreements. May be required to be in office two to three days a week to support teams performing provider on-site visits with appropriate documents and materials.

Works closely with other units divisions internal and external customers to facilitate quality related initiatives as directed by the QA Manager responding to inquiries as appropriate

Perform research and data gathering as requested.

Knowledge Skills & Abilities (KSAs) :

Knowledge of :

Behavioral Healthcare Delivery Systems

Familiarity with Native American Tribes / programs

Member psychosocial and medical needs

Medicaid Medicare Federal Regulations State Statute and Rule and policies applicable to AHCCCS programs

ICD and HCPC codes

Specific geography of Arizona and New Mexico and surrounding states

AHCCCS and DFSM Policies and Procedures

Familiarity of authorization and utilization review

Medical technology computer data retrieval and input

Skill in :

Problem solving skills

Excellent verbal / written communication skills

Organizational skills to coordinate monitor and report

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 socio economic backgrounds

Documentation and reporting of data and trends

Intermediate computer skills (i.e. Microsoft Office Suite Word Excel and Google)

Ability to :

Strong ability to collaborate with others for mutually beneficial outcome

Plan organize prioritize work and multitask in a fast paced environment

Understand clinical information

Read interpret and apply complex rules and regulations

Independent decision making yet knowing when to elevate the decision

Support unit in-office based on business needs

Drive long distances when required

Ability to work Virtual Office (VO) Telecommute or both

Selective Preference(s) :

Arizona Drivers License

Minimum : Two years of experience in a healthcare support role.

Preferred : Experience in Behavioral Health prior experience working with Tribal entities

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).

Benefits :

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 program here. For a complete list of benefits provided by The State of Arizona please visit our benefits page

Retirement :

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.

Contact Us :

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 :

IC

Key Skills

Invoicing,Information Technology Sales,IT Support,Audio Visual,Database Administration

Employment Type : Full-Time

Experience : years

Vacancy : 1