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.

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

Salary: $73,000 - $78,000  

Grade: 22

Closing Date: Open Until Filled 

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

Must reside in the State of Arizona. 

The Division of Fee For Service Management (DFSM) is looking for a highly motivated individual to join our team as a Pre-Payment Review Supervisor. Under the direction of the Prepayment and Audit Manager, this position is responsible for ensuring clinical documentation that is submitted by provider organizations in support of billed medical and behavioral health services is reviewed adequately, while applying knowledge of healthcare State, Federal and Arizona Health Care Cost Containment System (AHCCCS) laws policies and practices. The supervisor will be supervising a team of Pre-Payment Review Nurses. This position has the potential of conducting on-site review, in support of overall strategic goals of Division of Fee For Service Management (DFSM) and AHCCCS.

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.

• Ensure compliance with contractual, regulatory, and statutory obligations for Fee-for-Service (FFS) members' behavioral health services and behavioral health needs.
  
• Monitor trends in, over and underutilization, and conduct prepayment reviews, provide oversight and technical assistance, gather, plan, organize and evaluate information from multiple sources, including utilization data, case file reviews and audits.
  
• Supervise Pre-Payment Review Nurses and ensure each and overall unit is performing to the highest level and accordance to the direction of the Audit and Prepayment Manager and Claims' Leadership.
  
• Participate in the development and delivery of trainings related to the improvement of the overall pre-payment claims review process, and related areas.
  
• Facilitate team meetings, huddle boards, monthly Audit Committee and similar meetings. Meet with Claims' Leadership and/or other leaders to discuss overall unit objectives and develop a fluid management plan.
  
• Participate in, in-person clinical provider reviews by conducting provider on-site visits with the DFSM Quality of Care units as needed. Participate in internal and external meetings as requested to collaborate with others and ensure full understanding of team and departmental workflows.
  
• Become efficient in utilizing the AHCCCS information system called Prepaid Medical Management Information System (PMMIS), in order to process pre-payment reviewed claims and train staff.

Knowledge of:

• Service Authorization concepts, principles, and strategies.
  
• Advanced knowledge of the behavioral health service delivery system and the needs of children and the needs of individuals designated as SMI.
  
• Principles of behavioral health management and assessment.
  
• Individual service planning process and substance abuse treatment.
  
• HCPCS codes Levels I & II and, knowledge of International Classification of Diseases, DSM IV/V coding and medical billing guidelines.
  
• Medical technology, computer data retrieval and input, including EHR, HIE, etc.
  
• Medicaid and Medicare Federal Regulations, State Statute, Rules, and Policies applicable to AHCCCS programs.
  
• AHCCCS program design and implementation, prior authorization functions and responsibilities, provider network, and funding source.
  
• Familiarity with American Indian Tribes, programs and policy.
  

Skills in:

• Problem solving identification, evaluation, and imitation of appropriate action and case management assessment.
  
• Excellent verbal/written communication skills.
  
• Organizational skills to coordinate, monitor and report on multiple cases simultaneously.
  
• Analytical skills to identify and correlate specific patterns, initiate investigations, submit findings and recommendations.
  
• Strong interpersonal skills in working with people of diverse cultures and socioeconomic backgrounds.
  
• Documentation, research, and reporting of data and trends.
  
• Strong computer skills including Microsoft and Google Suite.
  

Ability to:

• Strong ability to collaborate with others for mutually beneficial outcomes.
  
• Interpret clinical information and assess implications for treatment.
  
• Read, interpret, and apply complex rules and regulations.
  
• Independent decision making yet knowing when to elevate the decision.
  
• Drive long distances when required.
  
• Ability to work Virtual Office or Telecommute or both.

Possession of a Arizona Driver's License

Minimum Qualification:

• Possession of a current license to practice as a registered nurse in the State of Arizona
  
• Three (3) years professional experience related to health programs appropriate to the assignment, which includes program planning or administration; OR (2) plus years as an AHCCCS Health Care Nursing Consultant.
  

Preferred Qualification:

• Experience in Behavioral Health services, auditing, American Indian Health plans function and/or experience in claims processing and payment.
  
• Managerial experience preferred.

• 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.