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State of Arizona · 2 hours ago

Provider Enrollment Customer Service Representative

Phoenix, AZ

Full-time

Hybrid

Entry, Mid Level

$38K/yr - $38K/yr

2+ years exp

The State of Arizona, through the Arizona Health Care Cost Containment System (AHCCCS), is seeking a Provider Enrollment Customer Service Representative. This role is responsible for conducting provider enrollment, assisting providers with application processes, and ensuring compliance with CMS Medicaid facility requirements.

GovernmentOffice AdministrationPublic Relations

Responsibilities

Assisting AHCCCS Providers in processing their application, answering questions and collecting information. Assisting over 100 different provider types and knowledge of eligibility criteria for each provider type

Site Visits, both individually and in a team of 2, depending on the scope of the visit and distance. Visits will determine the enrollment of services being provided by Provider. Determine that Services, Offices, and equipment are operable and match information provided on the application completed by Provider

Determining eligibility of Provider based on CMS guidelines. Research provider demographics in PECOS, follow CMS audit process/guidelines regarding compliance of Medicare Debt and billing practices and encounters

Assess risk level and in depth screening of Providers to ensure excluded providers are eliminated from Medicaid Enrollment Compile all documents for Provider disciplinary action for AHCCCS Medical Review board

Act as an AMS Team Lead on projects and presentation of section's statistics. Share Assignment results with the team, suggest process flow changes. Interpret policy and procedure changes. Assist with training new staff by providing on the job training techniques, and mentorship

Studying statutes, rules, policy manuals and clarifications. attending training and conferring with supervisor and others to improve skills and maintain expert level of knowledge

Qualification

Medicaid ProgramsCMS guidelinesProvider Enrollment PortalInterviewing techniquesProblem-solving skillsBasic computer skillsBilingual (Spanish)Communication skillsTeamwork

Required

Two and a half years of experience in a multi-functional customer service environment

Knowledge of Medicaid Programs and Prepaid Medical Management Information System (PMMIS) and/or PECOS

Expert knowledge of CMS State statute

Rules and regulation relating to the determination of eligibility to become an AHCCCS Provider

AHCCCS Provider Enrollment Portal, APEP

Interpretation of written and verbal information

Troubleshooting and problem-solving skills, research methodologies

Independent working skills (requiring a minimum of supervision)

Interviewing techniques to elicit information

Effective verbal and written communication

Basic computer skills

Good communication skills when interacting with internal and external entities

Google and/or word processing, spreadsheet and database applications and proprietary healthcare computer systems such as APEP

Ability to work within a team environment

Function effectively in an orderly and purposeful manner in situations of stress or tension

Work with the public in less than ideal conditions

Deal with multiple tasks at one time

Listen, comprehend and offer guidance to questions surrounding Medicaid enrollment through in-person or telephonic interviews

Successfully pass fingerprint background check, prior employment verifications and reference checks

Travel may be required for State business

Employees who drive on state business must complete any required driver training 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