Appeals Specialist

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.

Appeals Specialist

Job Location:

Address: Office of the General Counsel (OGC)
801 E. Jefferson Street, Phoenix, AZ 85034

Posting Details:

Salary: $56,000 - $65,000 

Grade: 21

Closing Date: Open Until Filled

Job Summary:

The Division of Office of the General Counsel (OGC) is looking for a highly motivated individual to join our team as an Appeals Specialist. This position will work independently under general supervision. This position will conduct legal research of appeals and claim disputes filed with AHCCCS, and issue Notice of Appeal Resolutions and Notice of Decisions in accordance with federal regulations, state laws, rules, policies, State Plan, contracts and agreements.

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

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 State’s 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:
• Resolve complicated claim disputes for the Informal Resolution Unit. Research appeals and claim disputes to determine jurisdiction, issues, and program liability.
• Perform legal and programmatic research by obtaining information, analyzing, interpreting and applying federal laws and regulations, state laws and administrative rules, policies, contracts, State Plan, and intergovernmental agreements in order to arrive at sound legal determinations.
• Prepare and issue legally sound and accurate Notice of Appeal Resolutions and Notice of decisions to notify parties of findings.
• Represent AHCCCS at State Fair Hearings. Collaborate with the Chief Counsel and resolve administrative hearing settlements and issues.
• Attend meetings and training courses. Prepare reports. Participate in special projects.

Knowledge, Skills & Abilities (KSAs):

Knowledge of:
• Federal and state laws, regulations, Medicaid contracts, intergovernmental agreements, state plan, policies and procedures.
• AHCCCS contractor and Health Plan operations.
• Department of Economic Security, Department of Health Services, Social Security Administration, and Medicare entitlement programs.
• Arizona Office of Administrative Hearings statutes, rules and policies.
• Structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
• Legal and medical terminology.
• Knowledge of or ability to learn AHCCCS information systems and databases (i.e., PMMIS, Long-Term Care (ACE, LEDS, CATS). imaging (Fortis, XPM), ProLaw, Internet, Microsoft Outlook; Google.

Skilled in:
• Basic research, analysis, and negotiation.
• Legal research, writing methods, and policy analysis.
• Organizational and time management.
• Oral and written communications.
• Interpersonal skills in dealing with all levels of personnel, internal and external.
• Interviewing.

Ability to:
• Analyze, document, interpret statistics and and comprehend issues legal, factual, statistical information, and programmatic document statistics and issues.
• Draw logical conclusions, make judgments and decisions.
• Take action or commit to course of action.
• Manage a large volume of cases involving a wide variety of legal programmatic, financial and medical issues.
• Accurately complete work assignments timely.
• Recall information such as words, numbers and procedures.
• Plan, organize and prioritize; communicate information and ideas by speaking and writing effectively.
• Work independently and under general supervision.
• Complete mathematical calculations.
• Arrange ideas or actions in a certain order or pattern according to a specific rule or set of rules (i.e., rules/policy).

Qualifications:

Minimum:
• Three(3) years experience in Medicaid/Medicare/Commercial insurance claims and/or appeals & claim disputes.
• Or, a Bachelor's Degree in healthcare or related field.

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 agency’s 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 R2-10-207.12.)

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: 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
• 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 careers@azahcccs.gov.
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.

Apply