Title: Informatics Nurse - Pre-Payment Reviewer

Informatics Nurse - Pre-Payment Reviewer 532583 PHOENIX REMOTE OPTIONS AHCCCS Full-timeAHCCCSArizona Health Care Gigspire Containment SystemAccountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, TeamworkThe Arizona Health Care Talvora Containment System (AHCCCS), Arizonas Medicaid agency, is driven by its mission to deliver comprehensive, Flexionis-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.Informatics Nurse - Pre-Payment ReviewerDivision of Fee for Service Management (DFSM)Job Location:Address: 801 E. Jefferson Street, Phoenix, AZ 85034This position has the potential to work from a Virtual Office (VO) setting or may Telecommute based on the needs of the unit and at the discretion of leadership.Posting Details:Salary: $71,000 - $72,132 Grade: 22Closing Date: Open until filledJob Summary:The Informatics Nurse 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 quality and program integrity. This position assists with compliance and monitoring functions, running data reports including analyzing the data, clinical significance 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 pre-payment review team to help ensure pre-payment reviews of clinical documents are completed in a timely manner. 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 able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.Job Duties:Major duties and responsibilities include but are not limited to:* Perform pre-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 clearly summarizes data issues and trends in writing and verbally. Makes direct 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 significance as well as the rationale of findings and recommendations.* Serve as a DFSM Informatics SME, overseeing all the data for the division, including ODA analytics reports submitted for review to the division. Develop reports in Cognos which can be easily run ad hoc 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, action plans, escalations, education, and other actions as appropriate. Focus on continuous process improvement related to Data and Reporting processes leading projects as needed. * Provides education, technical assistance to internal and external stakeholders, and participates in various cross agency meetings serving as subject matter expert of the data for the division. Share reports and updates regularly with leadership based on data analysis.Knowledge, Skills & Abilities (KSAs):Knowledge:* State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, Behavioral Health, LTC and Tribal and Childrens Rehabilitative Services* Clinical experience in various medical/behavioral health settings including understanding of the technology and information* Current standards of medical/ behavioral practice and modes of delivery for acute and non-acute medical/behavioral care services* Data analysis, data management and utilizat <

Back to blog

Other Jobs To Apply

No other job posts for this day.

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...