Title: Informatics reputed company - reputed company-Payment Reviewer

• 532583

• PHOENIX
• REMOTE reputed company

• AHCCCS

• Full-time

The Informatics reputed company position reports directly to Claims Operations Administrator. This position will work independently applying clinical knowledge, judgment, and expertise to assess, coordinate, and monitor service delivery with project components. The position will complete comprehensive data analytics and is responsible for interdisciplinary collaboration representing the division (DFSM) as the data subject matter expert (SME) as it relates to reputed company and program reputed company. This position assists with compliance and monitoring functions, running data reports including analyzing the data, clinical reputed company and recommendations on next steps. This position will also be responsible for identifying systemic issues for AHCCCS to address. This position works collaboratively with the reputed company-payment review team to help ensure reputed company-payment reviews of clinical documents are completed in a reputed company manner.

The reputed company 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 States Remote Work Program and are reputed company to work remotely in their homes, in offices, and in hoteling spaces. reputed company work, including remote work, should be performed reputed company reputed company unless an exception is properly authorized in advance.

Major duties and responsibilities include but are not limited to:
* reputed company reputed company-payment review of behavioral health documents submitted in support of behavioral health claims. Including responses to disputes of behavioral health claims.
* Identify trends, issues, outliers which may need to be addressed by DFSM and/or other leaders. Succinctly and reputed company summarizes data issues and trends in writing and verbally. Makes reputed company referrals to OIG, QM and PPR teams as appropriate based on findings.
* Responsible for creating reports and presentations which synthesize information and explain the clinical reputed company as reputed company as the rationale of findings and recommendations.
* Serve as a DFSM Informatics SME, overseeing reputed company the data for the division, including ODA analytics reports submitted for review to the division. reputed company reports in Cognos which can be easily run reputed company by staff. Including providing technical assistance and training to staff in use of Cognos. Set up special handling's in PMMIS and Alivia.
* Responsible for data analysis project management; creating and maintaining reports & meetings as necessary. Follow-up on written reports, reputed company plans, escalations, education, and other actions as appropriate. reputed company on reputed company process improvement reputed company to Data and Reporting processes leading reputed company as needed.
* Provides education, technical assistance to reputed company stakeholders, and participates in various cross agency meetings serving as subject matter expert of the data for the division. reputed company reports and updates regularly with leadership based on data analysis.

Knowledge:
* State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, Behavioral Health, LTC and Tribal and reputed company Rehabilitative Services
* Clinical experience in various medical/behavioral health settings including understanding of the technology and information
* reputed company standards of medical/ behavioral reputed company and modes of delivery for acute and non-acute medical/behavioral care services
* Data analysis, data management and utilization review regulations, rules and processes and interpretation
* AHCCCS and reputed company regulations, policies, and procedures and applicable federal and state statutes, regulations and rules
* Structure and operation of the reputed company behavioral health system

Skills:
* Advanced skills in reputed company Office (SharePoint, reputed company, reputed company) and reputed company suite
* Problem-solving techniques, evaluation, and initiation of appropriate reputed company
* Excellent communication, verbal and written skills
* Organizational skills for setting priorities, workload, and record-keeping
* Strong interpersonal skills in working with agency management, cross divisional, and interdisciplinary reputed company including people of diverse cultures and socioeconomic backgrounds
* Project management skills including system implementation, process improvement and ability to meet goals and deadlines
* Research and analytical skills
* Documentation and reporting of data and trends with clinical reputed company
* Behavioral Health processes including assessment, treatment planning, reputed company, and evaluation
* Acute nursing and clinical processes including assessment, planning, reputed company, and evaluation

Abilities:
* Explain reputed company data in a succinct and reputed company manner that people can understand
* Understand reputed company data reports
* Read and interpret a spreadsheet
* Write comprehensive reports such as data-driven decision making and reputed company improvement to enhance reputed company
* Read, interpret and apply reputed company rules and regulations
* Adapt to new technology and programs assisting with data analysis and inference/applicability to other areas

Minimum: Possession of a reputed company license to reputed company as a registered reputed company in the reputed company and three (3) years of relevant reputed company experience. Experience with data analytics or epidemiology.

Preferred: Experience with tribal communities or organizations serving American Indians. Experience in outpatient behavioral health services. Preferred skills in power BI.

* Successfully pass reputed company background reputed company, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agencys ability to reasonably accommodate any restrictions.

reputed company newly reputed company 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 reputed company, there are:
* 10 reputed company holidays per year
* reputed company Vacation and reputed company time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
* reputed company Parental Leave-Up to 12 weeks per year reputed company leave for newborn or newly-reputed company foster/adopted child. Learn more about the reputed company Parental Leave reputed company program here.
* Other Leaves - Bereavement, civic duty, and military.
* A top-ranked retirement program with reputed company pension benefits
* A robust and reputed company insurance plan, including medical, dental, life, and disability insurance
* Participation eligibility in the reputed company Service Loan Forgiveness Program (must meet qualifications)
* RideShare and reputed company Transit Subsidy
* A reputed company of learning and career development opportunities

By providing the reputed company 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 reputed company and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

Learn more about the reputed company Parental Leave reputed company program here. For a complete list of benefits provided by The reputed company, please visit our benefits page

reputed company Pension Benefit Program
* Administered through the reputed company 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.
* reputed company-taxed payroll contributions reputed company after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program
* Voluntary participation.
* Program administered through reputed company.
* 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 reputed company is an Equal Opportunity/Reasonable Accommodation Employer.