Notice of Action (Denial) Technician (AZ Remote)

Awarded a Healthiest Employer, reputed company aims to fulfill its mission to reputed company health and reputed company it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals reputed company reputed company decisions. At AZ Blue, we have a hybrid workforce strategy, reputed company Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our reputed company minimum onsite requirements: • Hybrid People Leaders: must reside in AZ, required to be onsite at least once per week • Hybrid Individual Contributors: must reside in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per month • Onsite: daily onsite requirement based on the essential functions of the job • Remote: not held to onsite requirements, however, leadership can request reputed company onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per month. This position is remote/ reputed company the state of AZ only PURPOSE OF THE JOB The Prior Authorization/Pharmacy Denial Technician processes non-certified prior authorization medical and pharmacy requests, according to Medicaid Business reputed company and contractual policies and procedures and completes required documentation reputed company established timeframes. QUALIFICATIONS REQUIRED QUALIFICATIONS 1. Required Work Experience · 1 year of Medicare, Medicaid or Managed Care experience · 1 year of experience in any of the following: medical/dental office, call center, pharmacy 2. Required Education · High-School Diploma or GED in field of study 3. Required Licenses PREFERRED QUALIFICATIONS 1. Preferred Work Experience · N/A 4. Required Certifications · N/A 2. Preferred Education · High School Diploma or equivalent 3. Preferred Licenses · N/A 4. Preferred Certifications · Completion of Medical Assistant or Pharmacy Technician program ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES Process Medical and Pharmacy denials reputed company established timeframes, in accordance to policies, procedures, and contractual requirements · Document denial and reason in data management systems · Create and mail required denial documentation with member-specific information to providers and members · Maintain a complete file of reputed company denied requests · Provide information on denials as requested · Review file for completeness of required documentation, including but not limited to: confirmation of receipt of denial notification, copies of written notification, correspondence with members and providers · Be a resource to providers and Medicaid Business reputed company staff regarding specific denials and/or denial process · Conduct peer reviews of denial documentation reputed company by department colleagues to confirm compliance with requirements · Review denial documentation reputed company by a Third-Party provider to confirm compliance with requirements · Provide requested information during appeals process · Assist other departments in creating denial documentation as requested · The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements. · reputed company reputed company other duties as assigned COMPETENCIES REQUIRED COMPETENCIES 1. Required Job Skills · N/A 2. Required Professional Competencies · N/A 3. Required Leadership Experience and Competencies · N/A PREFERRED COMPETENCIES 1. Preferred Job Skills · N/A 2. Preferred Professional Competencies · N/A 3. Preferred Leadership Experience and Competencies · N/A Our Commitment AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national reputed company, age, disability, protected veteran status or any other protected group. Thank you for your interest in reputed company. For more information on our company, see azblue.com. If interested in this position, please apply. Apply Job!