AHCCCS

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

Salary: $72,000 - $78,000 

Grade: 23

Closing Date: Open Until Filled

This position manages the day-to-day operations of the Appeals Unit, including the appeal and claim dispute processes and work product. The Appeals Unit is responsible for the adjudication of appeals, claim disputes, and contractor requests for hearing. This position directly manages the representation of AHCCCS at State Fair Hearings.

This position works with the Assistant Director of the Office of the General Counsel, as well as other divisions within AHCCCS, to review operating decisions and decisions regarding the appeal, claim dispute, and request for state fair hearings process. The appeal, claim dispute, and request for state fair hearing files contain protected health information (HIPAA).

Major duties and responsibilities include, but are not limited to:
• Supervise and manage non-attorney appeals staff in the performance of their duties. Responsible for reviewing, identifying the issue for appeal, and assigning out appeals to individual appeal specialists. Provide assistance, coaching, and review for appeal specialists and their completed work product (Notice of Appeal Resolutions and Notice of Decisions).
• Representative of OGC for identification and elimination of inefficient process steps and/or programmatic areas that impact grievances and appeals, inter-division efforts for continuous improvement with DFSM Claims unit. OGC representative regarding any technical questions, improvement, and new software that impact grievance and appeals processes, with ISD.
• Conduct operational and financial reviews of contractor grievance systems.
• Represent AHCCCS at State Fair Hearings. Collaborate with General Counsel and resolve administrative hearing settlements and issues.

Knowledge:
• Comprehensive knowledge of federal and state laws, regulations, Medicaid contracts, intergovernmental agreements, State Plan, policies, and procedures
• Arizona Office Administrative Hearings statutes, rules, and policies
• AHCCCS Contractor and Health Plan operations
• Considerable knowledge of Department of Economic Security, Department of Health Services, Social Security Administration, and Medicare entitlement programs
• Legal and medical terminology
• Structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar
• Legal research, writing methods, and policy analysis
• AHCCCS Information Systems and Databases (i.e., PMMIS, Long-Term Care [ACE, LEDS, CATS], Imaging [Fortis, XPM], ProLaw, Internet, Microsoft Word, Microsoft Excel, Microsoft Outlook), Information Mapping

Skills:
• Performing competent research
• Identifying relevant issues and strong analytical, interpretive and logic skills, evaluative and problem-solving skills
• Management skills, including time management, planning, organizing, implementing, directing, and controlling the activities of personnel and activities in the Unit
• Effective written and oral communication; strong writing, revision and editing skills
• Maintaining complex and difficult working relationships
• Teaching, mentoring, and developing motivational behavior with employees
• Critical thinking
• Statistical
• Interviewing
• Project Planning
• Meeting Facilitation

Abilities:
• Analyze, interpret, and comprehend complex legal, factual, and programmatic documents and issues; Arrange ideas or actions in a certain order or according to a specific rule or set of rules/policy.
• Draw logical conclusions, make judgments and decisions, act or commit to course of action
• Work with a large volume of cases involving a wide variety of legal, programmatic, financial, and medical issues
• Plan, organize, and prioritize staff assignments
• Communicate information and ideas by speaking and writing effectively
• Remember information such as words, numbers, and procedures
• Work independently & with other AHCCCS divisions
• Accurate reporting of trends and ability to plan for process response
• Conduct contractor operational reviews including face to face contractor staff interviews
• Negotiate with appellants and/or their legal representative

Minimum:
• Five years of demonstrated management experience.

Preferred:
• Five years of experience in health care law and administrative law working in the public sector

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

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).

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 (pilot program).
• 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

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.

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.