H2O Claims & Prior Authorization Specialist

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.

H2O Claims & Prior Authorization Specialist

DFSM - Division of Fee For Service Management

Address: 801 E. Jefferson Street, Phoenix, AZ 85034

This position has the potential to work from a virtual office (VO) setting or may telecommute based on the needs of the unit and the discretion of leadership.

Must reside in Arizona.

Salary: $45,000 - $50,000 

Grade: 19

Closing Date: Open Until Filled

Under the direction of the H2O Claims & Prior Authorization manager, this position is responsible for ensuring prior authorization, claims, and audits for the state-wide H2O health program to the AIHP Serious Mental Illness (SMI) population are reviewed and processed promptly. The claims and prior authorization specialist will verify that prior authorization requests and claims documentation from the H2O program administrator and provider organizations adhere to State, Federal, and AHCCCS regulations, policies, and procedures. This position will assist the manager with monitoring the utilization of H2O services, collect data, and conduct program audits as directed.

This position is funded by a grant and is contingent upon the availability of funding.

Major duties and responsibilities include, but are not limited to:
• Adjudicates claims, processes prior authorizations, and enters data. Reviews prior authorization requests for services. Assesses clinical documentation to monitor, evaluate, and authorize services. This includes ensuring medical documentation is appropriately filed, stored, linked to claims and meets rules established for medical necessity, service appropriateness, quality of care, and ensuring compliance with contractual state and federal obligations that govern the provision of covered services. …