Notice of Action (Denial) Technician (AZ Remote) ID-10216

November 23, 2024

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make 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 make better health decisions.

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This position is remote/ within 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 Segment and contractual policies and procedures and completes required documentation within established timeframes.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

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

Required Education

High-School Diploma or GED in field of study

Required Licenses

PREFERRED QUALIFICATIONS

Preferred Work Experience

Required Certifications

Preferred Education

High School Diploma or equivalent

Preferred Licenses

Preferred Certifications

Completion of Medical Assistant or Pharmacy Technician program

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

Process Medical and Pharmacy denials within 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 all 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 Segment staff regarding specific denials and/or denial process
Conduct peer reviews of denial documentation prepared by department colleagues to confirm compliance with requirements
Review denial documentation prepared 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.
Perform all other duties as assigned

COMPETENCIES

REQUIRED COMPETENCIES

Required Job Skills

Required Professional Competencies

Required Leadership Experience and Competencies

PREFERRED COMPETENCIES

Preferred Job Skills

Preferred Professional Competencies

Preferred Leadership Experience and Competencies

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 origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

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