Under the direction of the NOA Senior Mgr., the primary purpose of this position is to process all Notices of Action (NOA) and Notices of Non-Medical Coverage (NOMNC) for services accurately and in a timely manner.
Reviews all UAHP denials for eligibility, expiration date, accuracy and completeness.
Writes all member information in AHCCCS/SNP approved NOA/NOMNC templates to meet regulatory requirements.
Enters all denials/partial denials/service reductions into the computer systems.
Performs other related duties, consistent with the goals and qualifications of this position.
Works cooperatively with both internal and external customers in assisting members and providers with referral related issues.
Call rotation for the health plan, as well as departmental call rotation for holidays.
Meets internal and external customer service expectations regarding duties and professionalism.
This position performs all related duties in a manner that is consistent with and in support of the organization's mission, vision, values and goals.
Current, unrestricted AZ LPN license permitting work in the State of Arizona. A minimum of three years experience in an acute care setting. At least two years of experience in prior authorization or utilization management, knowledge of insurance, managed care principles, and community facilities and resources.
Proficient on a computer (PC) with Microsoft Office Products. Ability to work with data bases/programs, such as IDX and ability to work independently, with analytical, problem solving, decision making, concurrent and retrospective data management skills are necessary. Working knowledge of medical terminology and coding (ICD-9, CPT-4) is required.
Experience specific to ICU/Med. Surg. and knowledge of Arizona Health Care Cost Containment System (AHCCCS) and Centers for Medicare and Medicaid Services (CMS) regulations preferred.Knowledge of AHCCCS, CMS and regulatory requirements and working knowledge of clinical criteria such as Milliman Care Guidelines is preferred.
Additional related education and/or experience preferred.
Internal Number: 262039
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.