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The specialist is responsible for completing eligibility determinations for various Medicaid programs and conducting quality assurance reviews. They also act as a primary point of contact for community partners, providing support, training, and identifying error trends to improve application quality.
AHCCCSArizona Health Care Cost Containment System
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| Job Location: |
| Posting Details: |
| Job Summary: |
The Community Partner Eligibility Specialist are responsible for completing eligibility determinations and quality assurance reviews, as well as consulting on findings with unit leadership. Reviews may be completed pre or post disposition. Programs include but are not limited to: MAGI, SSI-MAO, MSP, ALTCS, Freedom to Work, and KidsCare.
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:
• Acts as a primary point of contact for Community Partners and assistors providing advanced support for issues not resolved by the Community Assistor Call Center. Determine eligibility on various programs. Review eligibility determinations and asses the need for re-determination if appropriate. Perform routine inquiries in various systems to research and respond to inquiries. May respond in a call center environment.
• Participates in the CP-AO eligibility determination process, coordinates HEAplus access, performs outreach activities and training, and facilitates and drafts communications to the CP-AO partners. Manages email requests and CPAO inquiries, Coordinates with other divisions and units as necessary.
• Identify error trends, training needs, and suggest updates in an effort to improve the quality of applications created by CP-AO partners. Provides support and direction based on research, analysis and interpretation of program rules and regulations. Perform routine QA reviews on the work completed by CP-AO partners. Participates in the creation of materials provided to the CP-AO population.
• Participate in internal and external meetings fostering teamwork and collaborative efforts. Provides continual internal and external customer service in support of agency and division mission and values. Assists in training new internal or external CP-AO team members as needed.
| Knowledge, Skills & Abilities (KSAs): |
Knowledge of:
• Federal and State laws and regulations governing the MAGI, SSI-MAO, MSP, ALTCS, Freedom to Work and KidsCare programs
• AHCCCS Acute Care and ALTCS eligibility categories and financial eligibility policies and procedures
• Interview skills and techniques
Skilled in:
• Researching and interpreting Federal and State laws, statues, rules, regulations, policies, procedures and guidelines
• Problem identification and resolution
• Communication skills both, verbal and written, along with good interpersonal skills
• Assessing, reviewing and analyzing information
• Adhering to policies and procedures
• Computer systems, databases, and programs to include HEAplus, PMMIS, Docuware, RightFax and Asset Verification System (AVS), Microsoft Office
Ability to:
• Work independently
• Organize and prioritize work assignments
• Document accurately and effectively
• Review electronic case files
• Relate to other employees with patience, courtesy and tact
• Conduct training
• Perform basic mathematical calculations
| Selective Preference(s): |
Arizona Drivers License
Minimum: Must have a high school diploma or General Equivalency Diploma (G.E.D) and 3 years of customer service experience.
Preferred: Two years of work experience equivalent to a Benefit & Eligibility Specialist or Program Services Evaluator (e.g., interviews and determines eligibility for public assistance benefits).
| Pre-Employment Requirements: |
• 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).
| Benefits: |
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 program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page
| Retirement: |
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.
| Contact Us: |
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.
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