APPEALS SPECIALIST

DEPARTMENT OF ECONOMIC SECURITY Your Partner For A Stronger Arizona. DES works with families, community organizations, advocates and state and federal partners to realize our collective vision: A thriving Arizona. DES serves more than 3 million Arizonans. Our Mission is to strengthen individuals, families, and communities for a better quality of life. APPEALS SPECIALIST Job Location: Division of Developmental Disabilities (DDD) 1789 West Jefferson Street, Phoenix, Arizona 85007 Salary: $53,000.00 - $55,000.00 Grade: 21 Closing Date: July 20, 2026 Job Summary Would you like to be part of an amazing team that helps Arizonans thrive? At the Department of Economic Security (DES), we strengthen individuals, families, and communities for a better quality of life. DES is looking for individuals that are committed to service, community, and teamwork. To learn more about DES, please visit des.az.gov or view our Our DES video. Come join the DES Team! The Department of Economic Security, Division of Developmental Disabilities (DDD), is seeking an experienced and highly motivated individual to join our team as an Appeals Specialist. DDD provides individuals with developmental disabilities and their families with services and supports that are flexible, high-quality, and member-driven. These services provide individuals with opportunities to exercise their rights and responsibilities of independent decision-making and engagement in the community. Applicants for this position cannot be licensed or certified by the DDD Office of Licensing, Certification and Regulation, cannot have a principal interest in or have a spouse or close family member with a principal interest in a DDD Qualified Vendor Agreement, and cannot be employed or subcontracted by a DDD Qualified Vendor. Job Duties Receiving verbal or written appeals, claim disputes & requests for administrative review from members, legal representatives, providers & other stakeholders. Reviewing appeals, claim disputes & requests for administrative review upon receipt to determine compliance with applicable Federal & State statutes. Confers with DDD staff, members, legal representatives, health plan representatives, the AG's Office, and other stakeholders. Analyzes documentation to determine if the adverse action taken by DDD complies with federal & state regulations. Prepares & provides written decisions in compliance with the established time frames, legal representatives, health plans, DDD staff, the AG's Office & other stakeholders in response to appeals, claim disputes & requests for administrative review. Receives & reviews written requests for State Fair Hearings received from consumers, legal representatives, providers & other stakeholders upon receipt to determine compliance with federal & state statutes. Coordinates & prepares documentation submitted to the AHCCCS in response to requests for State Fair Hearings. Gathers & prepares written & physical evidence for review by the AG's Office in preparation for State Fair Hearings. The AG's Office prepares witnesses for hearings. Testifies on behalf of the Division at hearings. Represents the Division at all hearings & approves all settlements reached by relevant parties during the State Fair Hearing process. Coordinates & monitors the implementation of all settlements with Division staff, health plans & other stakeholders. Communicates all AHCCCS Director decisions to DDD & health plan staff. Ensures that the AHCCCS Director's decision is implemented as written. Acts as liaison to the AG's Office, health plans & DDD in preparation for hearings. Under general supervision, exercising independent judgment within federal & state statutes, administrative law & policies/procedures. Ensures timeliness & quality of work products. Review the corrective action plan to determine compliance with federal and state regulations. Monitors the implementation of the corrective action plan to ensure compliance with federal and state regulations. Coordinates all deposition activities with DOA Risk Management, the Attorney General's Office, DES/DDD staff, and other stakeholders. Testifies at litigation hearings as required. Represents the DES/DDD during all settlement discussions. Completes activities associated with contract deliverables, including monitoring AdSS during ORs & Oversight Meetings; reviews & evaluates documents, reports, & deliverables submitted by AdSS; aggregates AdSS info into Division deliverables with AHCCCS; ensures timelines are met; reviews and is very knowledgeable of the AHCCCS contract with the Division, especially related to areas of their expertise and authority. Knowledge, Skills & Abilities (KSAs) Knowledge in: Comprehensive knowledge of state and federal laws and regulations governing the IDD Medicaid population. Knowledge of the Grievance, Appeals, and Hearing Process. Knowledge of Arizona Revised Statutes, Code of Federal Regulations, and Arizona Administrative Code. Skills in: Excellent oral skills. Interpersonal relations with agency management, staff, agency attorneys, consumers and their families, and the public. Applying good judgment to manage a high volume of volatile issues from stakeholders, the public, etc. Analysis, evaluation, and interpretation of a wide variety of programmatic information and data. Tracking time-sensitive litigation, HIPAA violations, and appeal resolution action items. Possess excellent writing skills with the ability to write technically, clearly, and concisely. Ability to: Speak effectively and factually to the public, courts, leadership, etc. Prioritize work to successfully manage tasks and utilize methodologies for process improvements and change management. Analyze data and form sound decisions; ability to speak in front of administration, peers, court proceedings, and the general public; Write technical, accurate, and understandable terminology in documents that relate to litigation, confidentiality, and corporate compliance; Successfully manage tasks, conflicting priorities, and deadlines; Investigate and contact the appropriate entities as they relate to HIPAA violations and litigation. Creating, organizing, and maintaining case files adhering to all legal and departmental standards. Selective Preference(s) The ideal candidate for this position will have: Bachelor's or Master’s degree in Social Services, Justice Studies, Humanities, or any related field. Spanish speaking is preferred. Pre-Employment Requirements If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements. Any employee operating a motor vehicle on State business must possess and retain a current, valid class-appropriate driver's license, complete all required training, and successfully pass all necessary driver's license record checks. The license must be current, unexpired, and neither revoked nor suspended. Employees who drive on state business are subject to Driver's license record checks, must maintain acceptable driving records, and must complete all required driver training. An employee who operated a personally owned vehicle on state business shall maintain the statutorily required liability insurance. Successfully pass background and reference check; employment is contingent upon completion of the above-mentioned process and the Agency's ability to reasonably accommodate any restrictions. All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify). Benefits The Arizona Department of Economic Security offers a comprehensive benefits package to include: Affordable medical, dental, life, and short-term disability insurance plans Participation in the Arizona State Retirement System (ASRS) and long-term disability plans 10 paid holidays per year Paid vacation and sick time Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child Deferred compensation plan Wellness plans Tuition Reimbursement Stipend Opportunities Infant at Work Program Rideshare and Public Transit Subsidy Career Advancement & Employee Development Opportunities Learn more about the Paid Parental Leave program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page. Retirement State employees are required to participate in the Arizona State Retirement System (ASRS), the state-sponsored retirement contribution plan, and the Long-Term Disability (LTD) program after a 27-week waiting period. The ASRS defined benefit plan provides for lifelong income upon retirement. You will also have the option to participate in a voluntary deferred compensation program to take advantage of tax-deferred retirement investments. On or shortly after your first day of work, you will be provided with additional information about the available insurance plans, enrollment instructions, submission deadlines, and effective dates. Contact Us For questions about this career opportunity, please contact Ariana Dominguez at View phone number on click.appcast.io or View email address on click.appcast.io. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation, such as a sign language interpreter or an alternative format, by contacting View phone number on click.appcast.io or View email address on click.appcast.io. Requests should be made as early as possible to allow time to arrange the accommodation. #J-18808-Ljbffr