COMPLIANCE, APPEALS & DISPUTES MANAGER

Arizona Department of Child Safety

A New Beginning for Arizona’s Children

COMPLIANCE, APPEALS & DISPUTES MANAGER

Comprehensive Medical & Dental Program

Audit and Compliance
3003 N. Central Avenue

Phoenix, AZ 85012

http://www.azdcs.gov

DCS Mission Statement

JOB SUMMARY:

Do you have experience in Health Care Compliance? The Department of Child Safety (DCS) is in search of a Compliance, Appeals and Disputes Manager to ensure compliance with Medicaid and child welfare laws related to health care for children in DCS custody. The ideal candidate will serve as the primary point of contact for Arizona Health Care Cost Containment System (AHCCCS) communications, and coordinates the tracking and submission of all contract deliverables. In addition, this position is responsible for performing contractual duties related to the AHCCCS Grievance System.

The Comprehensive Medical and Dental Program (CMDP) within the Department of Child Safety (DCS), is a Medicaid managed acute health care program serving children and youth in foster care in the state of Arizona. CMDP works in partnership with DCS Specialists and foster care providers to make sure children in foster care get the medical services they need.

JOB DUTIES:

• Responds to AHCCCS inquiries, and coordinates contract requirements

• Oversees policy development and review

• Maintains tracking logs, data analysis, reports, and adjudication of grievances, appeals and claim disputes

• Prepares case files

• Coordinates and conducts audits

• Advises DCS leadership of compliance trends, legislative changes, and Intergovernmental Agreement (IGA) requirements

• Facilitates meetings, and various health plan committees

• Performs other duties appropriate to the assignment

KNOWLEDGE, SKILLS AND ABILITIES (KSAs):

Knowledge of:

• Organizational principles, regulatory methodologies, and management practices

• State legislative laws, regulations and rules related to behavioral health care and child welfare

• Principles of managed care

• Medical/dental billing, coding, and claims payment

• Medicaid or Commercial Health Plan Operations

• Common pediatric medical terminology

• Operational compliance within a managed care organization

Skill in:

• Organization

• Computer software, such as Word and Excel

• Analytical decision making

• Problem-solving and trouble-shooting

• Facilitation and project management

• Verbal and written communication

• Establishing and maintaining interpersonal relationships

Ability to:

• Prioritize numerous responsibilities

• Plan, and coordinate activities

• Effectively communicate to groups

• Navigate information systems

• Apply DCS policies and procedures

• Represent DCS within the community and state

SPECIAL SELECTION FACTOR(S):

Requires the possession of, and ability to retain a current, valid state-issued driver’s license appropriate to the assignment. Employees who drive on state business are subject to driver’s license record checks, must maintain acceptable driving records and must complete any required driver training (see Arizona Administrative Code R2-10-207.12).

Must be able to secure and maintain clearance from the CPS Central Registry.

PREFERRED QUALIFICATION(S):

• Certification in Health Care Compliance

• Experience in compliance/program administration, monitoring, auditing, or compliance in a managed care organization

• Experience in healthcare fraud, waste, and abuse

PRE-EMPLOYMENT REQUIREMENTS:

Employment is contingent on the selected applicant passing a background investigation.

BENEFITS:

We offer a comprehensive benefits package that includes:

• Sick leave

• Vacation with 10 paid holidays per year

• Health and dental insurance

• Retirement plan

• Life insurance and long-term disability insurance

• Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance

RETIREMENT:

Positions in this classification participate in the Arizona State Retirement System (ASRS).

Enrollment eligibility will become effective after 27 weeks of employment.