The CSR performs customer service activities by performing tasks related to answering customer inquiries received via telephone, in person, or through applications and correspondence. Primary duties include interaction with customers; interpreting basic program information, program eligibility information. Secondary duties may include data entry, or resolving complaints. This classification is responsible for providing excellent customer service; for accuracy and timeliness of work products; for correctly interpreting rules and regulations; for the security of member information, registering applications and for applying adequate problem solving techniques and methods.
The Program Services Evaluator performs duties related to the application of program rules, policies and procedures to make initial and/or continuing determinations of eligibility appropriate to the area of assignment such as AHCCCS Health Insurance, ALTCS, KidsCare, Freedom to Work and Medicare Cost Sharing Programs. Some travel may be required. Higher PSE classifications also provide supervisory and technical assistance in interpreting policies, rules and regulations for staff and customers and assists in training staff.
Individual positions may be responsible for some or all of the listed duties and/or other related duties. Assesses clients in a face-to-face interview using Pre-Admission Screening (PAS) instrument and computer system to determine medical eligibility for long term care; reviews medical and other ancillary records; interacts with others, e.g., client’s family members and/or caregivers, other professionals, physicians and other resources, to identify and evaluate medical and psychosocial conditions. Sorts through conflicting information from multiple sources to get information needed for determination.
Under direction, is responsible for work of average to considerable difficulty in planning, implementing and administering a state-wide health program which is typically limited in scope and specialized in nature or identified with a designated segment of the population; and performs related work as required. Higher grade managers may be responsible for a group of health programs and supervising a staff of professional and clerical personnel; and performs related work as required.
An Info Tech Specialist provide supervisory/lead/senior level computer operations services, personal computer (PC) installation/implementation, help desk support, desktop administration, workstation administration, network administration, network operation and support, information technology (IT) training, quality assurance, technical writing, security maintenance, basic programming and system testing. Some positions may be supervisory. Employees are assigned parts of projects or entire projects of moderate complexity.
High grade positions provide supervision of a data processing operations/production unit; perform standard and/or routine application programming, business systems analysis, testing of complex systems/processes, technical writing, Information Technology (IT) training, network administration, network operation and support, workstation administration, quality assurance, and configuration management. Some positions may be supervisory Employees at this level have the capability to define what needs to be done rather than completing projects outlined for them. Work requires technical analysis and design capabilities. Problem solving may require solutions that span several platforms using several languages in the client server, multitier or multiserver environment. At this level the work focus shifts to more analysis, design and planning.
The Claims Specialist is responsible for review, analysis, correction and adjudication of medical claims; for entry of claims information and corrections; and timely completion of claims reports. The specialist has the authority to approve or deny medical claims in accordance with AHCCCS rules and regulations; to ensure proper claims adjudication; to correct claim discrepancies; to refer record changes to appropriate area.
High grade specialists are responsible for accurate and timely claims resolution; for quality of completed work product in a timely manner; for identifying procedural problems and alternatives; for technical claims training. The specialist has the authority to provide clarification of AHCCCS claims processing policies and procedures; to analyze monthly reports and develop training material from problem areas found; to correct, approve or deny complex medical claims; to identify and recommend procedural changes. The specialist examines, evaluates, denies and/or pays claims for medical service; develops technical training to AHCCCS staff and service providers and monitors and evaluates providers' claims work systems.
