AHCCCS

Address: Division of Business and Finance (DBF)
801 E. Jefferson Street, Phoenix, AZ 85034

Must reside in Arizona.

Salary:$121,000  

Grade: 28

Closing Date: Open Until Filled

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 Division of Division of Business and Finance (DBF) is looking for a highly motivated individual to join our team as an Reimbursement Administrator. Under the direction of the DBF HC Finance Deputy Assistant Director, the Reimbursement Administrator is responsible for all agency provider reimbursement methodologies for Fee-for-Service (FFS) providers. These rates may be used or benchmarked by Managed Care Organizations for provider reimbursement. In this role, the position sets the strategic direction and provides operational oversight for teams of financial professionals that develop and implement complex reimbursement methodologies and ensure compliance with federal and state regulatory requirements. This position will serve as an Agency SME related to all matters associated with the Hospital Assessment Fund (HAF) and the Health Care Investment Fund (HCIF) and will update the DBF HC Finance Deputy Assistant Director related to any Hospital Assessment issues that need to be elevated to the Director’s Office. In addition to their work within their assigned area of responsibility this position interfaces with the Director, Deputy Directors, and Assistant Directors as well as other senior leadership positions across the Agency and the Governor’s Office on a regular basis.

This position is available for remote work on a full-time basis within Arizona (including virtual office arrangements).

OR
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:
• Oversee FFS rate development activities and supplemental payments to ensure adequacy, appropriateness, accuracy, and compliance with state and federal requirements. Evaluate and analyze trends in claims and encounter data to inform rate-setting decisions. Proactively engage with key providers and associations to address rate concerns as they arise, and maintain rates that are adequate to ensure access to care for members.
• Administer programs and policies governing all agency provider reimbursement methodologies and processes, including development of administrative rules and procedures, public notices, the FFS provider billing manual, and guidance to MCOs and providers. Lead and/or participates in numerous Agency key initiatives related to provider rates issues. Ensure appropriate representation of the Agency and serve as the Subject Matter Expert.
• Provide oversight and monitoring of all aspects of both the Hospital Assessment Fund (HAF) and the Health Care Investment Fund (HCIF) including development of assessment models producing approximately $1.2 billion of assessment funds, coordination of the distribution of over $2.2 billion of HEALTHII directed payments, and implementation of required regulatory documents for the State Plan, AZ Administrative Code, and policy.
• Build a team structure that supports the development of financial and rate setting professionals and supports each other as well as other units/Divisions across the Agency. Meet all deliverable deadlines. Support positive morale, address issues and concerns, and proactively address barriers.
• Present reimbursement oversight findings and recommendations to the Director, Deputy Directors and Assistant Directors on complex and controversial reimbursement issues with significant financial impacts. Present and defend proposed state plan amendments to the Centers for Medicare and Medicaid Services (CMS). Provide responses to questions from CMS, the Governor’s Office, the Legislature and internal staff related to work products developed.

Knowledge of:
• Rate setting methodologies for medical services.
• Comprehensive knowledge of federal and state laws and rules, regulations, and policies regarding provider reimbursement.
• Federal regulations relating to Medicaid and Medicare.
• AHCCCS Programs, Rules, and Regulations.
• Agency Policies and Procedures.
• Principles and practices of project management.
• Claims and encounter systems, processes, and data.
• Health care provider cost reporting methods and practices.

Skill in:
• Excellent leadership, management, and presentation skills.
• Excellent written and verbal communication skills, including the ability to communicate effectively with management and staff within the Agency, other state agencies and with CMS.
• Identification and resolution of complex financial, compliance and legal programmatic and regulatory issues.
• Strong analytical, organizational and problem-solving skills.
• Strong interpersonal relations skills in order to effectively work with high-level, key contacts both internal and external to the Agency (e.g., Director, Deputy Director, Assistant Directors, legal counsel, health plans, independent accountants and actuaries, other state agencies, other state Medicaid programs, representatives of the Governor's offices, etc.).

Ability to:
• Strong analytical ability.
• Prepare accurate, comprehensive reports.
• Evaluate situations and adopt an effective course of action.
• Establish and maintain effective working relationships.
• Interpret federal and state law and agency rules, regulations, policies and procedures.
• Multi-task in a fast paced environment where re-prioritization occurs frequently.
• Effectively assign, motivate, mentor, and develop experienced financial and rate setting professionals, including providing the training as necessary in their job functions.
• Effectively organize, supervise, and direct staff to ensure timely completion of multiple priorities. Accomplish through the ability to properly delegate and to follow-up and review task assignments.
• Develop and implement professional standards and policies.

Minimum:
• Five(5) years of experience in accounting or finance and management.
• And, a Bachelor's degree in accounting, business, finance or related field.

Preferred:
• Experience with financial analysis and provider rate setting.
• Medicaid managed health care programs experience is a plus.

• 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).

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

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.