Medical Eligibility Specialist
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.
Medical Eligibility Specialist
Division of Member and Provider Service (DMPS)
Address: 7202 E. Rosewood ST, Suite 125, Tucson, Arizona 85710
Open until filled: 1st review of resumes on date 02/21/2023
Start Date of 04/03/2023
This position is eligible for full-time remote work (including virtual office arrangement). Must reside in the State of Arizona.
The Division of Member and Provider Services is looking for a highly motivated individual to join our team as a Medical Eligibility Specialist (PAS Assessor). This position is to determine medical eligibility for customers applying for the Arizona Long Term Care Services (ALTCS) program. Comprehensive Pre-Admission Screenings (PAS) are completed during a face-to-face interview using a designated PAS instrument. Work independently and drive either a state vehicle or their personal vehicle to home and institutional settings to complete interviews and/or obtain documentation. Record actions taken on cases, maintains an electronic case file and updates the Health-e-Arizona Plus. A PAS Assessor may also be required to conduct financial eligibility interviews, complete applications and other forms and obtain verification of eligibility factors to determine the customer’s initial and ongoing financial eligibility and share of cost.
Major duties and responsibilities include but are not limited to:
- Drives a state or personal vehicle to conduct comprehensive interactive pre-admission screenings (initial and reassessments) utilizing HEAplus on all age groups in both institutional and community settings. Explains benefits, eligibility requirements and rights and responsibilities to customers.
- Manage and monitor PAS caseload and timeliness, schedule interviews, enter interview notes and score PAS, document follow-up actions with case notes, complete and close PAS assessments within application timeframes utilizing HEAplus.
- Obtains and reviews medical records and other relevant records; gathers data to support eligibility findings; interacts with informants such as family members and caregivers of customers, physicians and other professionals to identify and evaluate medical and psychosocial conditions.
- Interact with other state agencies such as Adult Protective Services (APS), Division of Developmental Disabilities (DDD) and Department of Child Safety (DCS).
- Contact applicants with the outcome of the PAS assessment and provide appropriate community resources for customers determined not eligible.
- Attends staff meetings and participates in exchange of professional information in support of the program. Works on special projects, completes financial eligibility interviews.
Knowledge, Skills & Abilities (KSAs):
- Medical, functional and psycho-social problems of the elderly physically disabled and developmentally disabled children and adults.
- Medical terminology and procedures.
- Available community resources, crisis intervention, counseling, advocacy, community relationships, and referral methods.
- Demonstrated knowledge of available community resources, crisis intervention, counseling, advocacy, community relationships, and referral methods.
- Fundamental principles of medical nursing services, alternatives to long term care, length of stay, pharmacology and equipment use.
- Experience with caseload management; schedules and timetables; effectively prioritizing; analyzing, assessing and evaluating service provisions and quality of care.
- Strong ability to establish and maintain effective working relationships with professional staff, caregivers, customers’ families, children and adults and with representatives of courts and various other agencies in the community.
- Ability to communicate effectively, both orally and in writing, reading, understanding and applying rules, regulations and policies.
- Ability to Elicit information and gain insight into customers and families; using a personal computer/laptop and computer programs to document information.
- Ability to solve mathematical problems accurately.
- 3 years of experience providing social service case management that included individual planning and delivery of health care services; OR Bachelors or Master’s degree with a major in Social Work, Rehabilitation, Counseling, Education, Sociology, Psychology, Nursing or other closely related field OR Graduation from an accredited school of nursing, with an active Arizona RN license.
- Chinle office only: Bilingual (fluent) in Navajo.
- AZ Driver’s License
- Bilingual (Spanish) a plus but not required (All offices other than Chinle)
* 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 is 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.
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)
* 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
* Opportunity to work 100% virtually or remotely on an ad-hoc basis (home office)
By providing the option of a full-time or part-time virtual/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.
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 email@example.com.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.