Job Description

Location: Health Choice Management Co.
Posted Date: 3/9/2020
The MIS Production Specialist position has the responsibility of managing many sources of data requests for research and update as well as processing, reviewing and triaging eligibility data sources. This role will also act as a quality assurance support role to ensure data integrity and accuracy. Regulatory reporting ownership around health plan enrollment and data cleanup and research are top priorities.

Responsibilities:

  • Perform analysis, research and corrections of data from provider agencies for Arizona Health Care Cost Containment System (AHCCCS) (now incorporating Arizona Department of Health Services (ADHS) and Division of Behavioral Health Services (DBHS) including but not limited to 834 data, demographic data, episode of care (EOC) dates and changes as well as EOC inserts
  • Researches and resolves errors returned by AHCCCS regarding encounters, demographics and enrollments
  • Works directly with AHCCCS to resolve enrollment, demographic and inter-RBHA transfer issues that cannot be corrected through normal processes
  • Serve as a contact for providers and regulators on Health Choice’s eligibility line working with providers in determining member eligibility
  • Provides required information to providers regarding medical authorizations
  • Responsible for responses to provider questions in submitting eligibility data to Health Choice
  • Liaison with Health Choice Member Services/Call Center to aid in Inter-RBHA (Regional Behavioral Health Authority) transfers and questions
  • Schedules and manages Health Choice data production jobs as assigned
  • Assists Pharmacy support team as needed
  • Provides backup to MIS Production Specialist
  • Runs MIS Production jobs including placing deliverables due to AHCCCS on the sFTP point and retrieving response and other files
  • Documents all production processes
  • Responds to questions and resolves data problems from providers concerning eligibility, demographics and encounters
  • Corrects member information in Health Choice systems as necessary
  • Participates in team meetings, provides training and information on enrollment, demographic and encounter processing
  • Provides input to policies and procedures as well as design of software tools needed to carry out assigned tasks
  • Performs testing as needed for new or revised software as well as claim solution changes and upgrades
  • Performs other duties as required

Education:

  • High school diploma or GED required

Years of Experience:

  • One year specialized or technical training beyond high school (preferred)
  • Two years computer skills experience
  • One year data analysis and entry
  • Two years customer service

Specialized Knowledge:

  • Microsoft Office software (Word, Excel, PowerPoint)
  • Microsoft SQL Query and relational databases

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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