Informatics & Prepayment Review Health Consultant

This 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 related 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 prepayment review and audit teams to help ensure prepayment reviews of clinical documents are completed in a timely manner.