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
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
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.