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Arizona State Fair Hearing Analyst - Phoenix, AZ

UnitedHealth Group

Phoenix, AZ
Job Code:
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Job Details

741391 Arizona State Fair Hearing Analyst Phoenix AZ

Arizona State Fair Hearing Analyst - Phoenix, AZ (741391)

Position Description

Position Description:
You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength and attention to detail. In return, we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life's best work.

This position falls within our Community & State Appeals and Grievances Department. You will consult with staff, including but not limited to QM (Quality Manager), Provider relations staff, Medical Management (including Prior Authorization), Member services, and Compliance / Legal.

Primarily you will be assigning cases, tracking / trending inventory, and hearing volumes. You will also analyze this data. Position performs claims, provider network, and State regulator contract and rules research and data mining. Position is responsible for the timely and accurate investigation of Grievance System administrative and compliance with State contracts requirements. Accordingly, to investigate, file creation, attending staffing for member grievances and appeals and provider claims disputes.

Primary Responsibilities:
  • Helps in data and report (trending) preparation to meet health plan and State timeliness requirements.
  • Review of incoming mail, logging and assigning cases to coordinators
  • Facilitating and preparing for weekly and monthly SFH (State Fair Hearing) meetings to include agenda, copies, invites
  • Prepare for review, responses to subpoenas, garnishments, record requests, liens, etc.
  • Familiarity with Federal and State laws, regulations, including A.A.C. Title 9, Chapters 34, State Medicaid policies, procedures, reimbursement, etc.
  • Maintain internal logs and prepare reports for health plan management and meeting State submission requirements
  • Assist in developing, implementing and timely preparing system reports and analysis
  • Investigate member appeals to assist in rendering timely and accurate decisions within AHCCCS-mandated criteria and within production and quality standards
  • Schedule and assist in preparation of witness (e.g., Medical Director) and arrange for appearance / telephonic requests of witnesses as well as exhibit gathering
  • Assists in preparation for and presentation of Medicaid grievances and claim disputes towards timely resolution, up to and including, in administrative hearings on government-funded managed health care programs: AHCCCS, DDD, Evercare and CRS matters
  • Conduct pre-administrative hearing investigation for appeals and claim disputes, document the findings (in the appeal files), help identify common factors as to whether appeal or claim dispute is a candidate for settlements and assist in settlement negations, as needed
  • Assists with filing Grievances and Appeals / Claim Dispute / request State Fair Hearing process; distinguishing between an inquiry, a Grievance, an Appeal, a Claim Dispute and a quality of care issue and know how to triage, resolve or refer incoming calls / correspondence to appropriate personnel
  • Docket hearing notices, contact State / Office of Administrative hearings, establish duties and time-frames in connection with each hearing and disseminate information with follow-up as appropriate
  • Provide testimony on behalf of the health plan and administrative hearing and represent the health plan at hearing when necessary and appropriate
  • Assists with internal segment and external vendor coordination, e.g., third-party liability, lien, primary insurance / coordination of benefit issues, questions
  • Other duties as assigned by manager
Required Qualifications:
  • High School Diploma / GED
  • Ability to work within standard business hours of 8:00 AM - 5:00 PM, Monday - Friday with the flexibility to work evenings or weekends as business needs arise
  • 3+ years of experience in either State Fair Hearing (SFH) or Appeals and Grievances
  • 3+ years of advanced professional reporting experience within Microsoft Excel including the ability to easily create pivot tables, VLOOKUP, and work with large data sets
  • 1+ years of experience preparing professional, data-driven narrative reports for all staff levels
  • 1+ years of experience utilizing Microsoft Word (create and edit documents) and Microsoft Outlook (send, receive emails, and manage calendar)

Preferred Qualifications:

  • State Fair Hearing (SFH) experience or exposure
  • Experience tracking and analyzing data
  • Bachelor’s Degree (or higher)
  • Experience managing incoming court documents
  • Experience managing work queue or assigning work to a team of 5 or greater
Soft Skills:
  • Strong organizational and analytical skills
  • Ability to balance conflicting priorities
  • Ability to communicate in a concise, professional manner
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in healthcare here. We serve the healthcare needs of low income adults and children with debilitating illnesses such as Cardiovascular Disease, Diabetes, HIV/AIDS and High-risk Pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive Healthcare, Community, and Government partners to heal healthcare and create positive change for those who need it most. This is the place to do your life’s best work.SM
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group
is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: UHG, UHC, Analyst, Appeals & Grievances, State Fair Hearing, SFH, data analysis

Job Details

  • Contest Number741391
  • Job TitleArizona State Fair Hearing Analyst - Phoenix, AZ
  • Job FamilyClaims
  • Business SegmentUHC Benefit Ops - CandS Ops

Job Location Information

  • Phoenix, AZ
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusExempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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