Health Plan LPN Notice Of Action

Banner Health Phoenix , AZ 85002

Posted 3 weeks ago

Primary City/State:

Mesa, Arizona

Department Name:

Prior Authorization

Work Shift:


Job Category:

General Operations

Bring your nursing passion for "making a difference" in people's lives and making healthcare easier so that life can be better, to us! That is our mission here at Banner-University Health Plans.

As a Prior Authorization Nurse, here, at Banner Insurance Division , you will have the opportunity to assist our members obtain the highest quality of care, while ensuring it is in the best setting for the member at the right time. We offer an autonomous working environment (In office and Working from Home) settings, Monday through Friday 8AM-5pm.

The PA department has a culture of "TEAM" that has been established by our Prior Authorization Management team. Each and everyone's' role here is needed equally to get the job done!

Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.

Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.


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.


1.Reviews all UAHP denials for eligibility, expiration date, accuracy and completeness.

2.Writes all member information in AHCCCS/SNP approved NOA/NOMNC templates to meet regulatory requirements.

3.Enters all denials/partial denials/service reductions into the computer systems.

4.Performs other related duties, consistent with the goals and qualifications of this position.

5.Works cooperatively with both internal and external customers in assisting members and providers with referral related issues.

6.Call rotation for the health plan, as well as departmental call rotation for holidays.

7.Meets internal and external customer service expectations regarding duties and professionalism.

8.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.

9.This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service. Interacts with staff at all levels throughout the organization.


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.

DATE APPROVED 06/07/2015

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Intake Coordinator LPN Home Health

Cornerstone Healthcare Group

Posted 4 days ago

VIEW JOBS 11/20/2020 12:00:00 AM 2021-02-18T00:00 Job Description About Us Cornerstone Healthcare Group, based in Dallas, Texas, was founded in 1990 and provides excellent healthcare services to our patients, residents and their families. Our employees make a difference, join us so you can too! We pride ourselves on our quality of care, responsive service, and commitment to excellence. We treat each employee, patient and resident like we would a member of our own family, and measure our success by the direct impact we have on improving the quality of life for our employees, patients and residents. The Intake Coordinator LPN must be able to perform the following essential job functions with or without reasonable accommodations. * Check, verify, and edit data coding to ensure compatibility with data entry system and procedural requirements. Interact with department representatives to resolve routine data coding problems. * Receive and route associated source paperwork to and from staff members. Work with department representatives as necessary to facilitate and expedite the efficient flow of documentation, and to resolve routine administrative problems. * Input and retrieve alphabetical and numerical information in prescribed format, using knowledge of computer software packages. * Maintain up to date orders, to include, DME, LABS, Disciplines and Frequency. * Extract and release information according to specified criteria and in strict compliance with established policies, procedures and/or regulations. Answer questions from client departments and others on specific data as requested, and prepare reports. * Ensure strict confidentiality of client records according to Policy and Procedures. * May lead, guide, and allocate work to employees on a task-by-task basis. * Maintain tracking of clinical orders and correspondence. * Communicate effectively, both orally and in writing. * Make administrative and procedural decisions and judgments on sensitive, confidential issues. * Knowledge of computer data entry systems, protocols and procedures. * Knowledge of relevant policies, procedures, and regulations pertaining to the release of confidential information. * Resolve data input, storage and/or retrieval problems and to design solutions and modifications. * Interact with other staff members to resolve problems and inquiries with in orders, 485's and frequency. * Establish and maintain efficient data and information flow. Qualifications/Educational Requirements: * Current state licensure, as Licensed Practical Nurse LPN * 2 years experience directly related to the duties and responsibilities specified. Competent in computer programs, such as, home health software, MS Word and Excel as well the ability to use standard office equipment. Cornerstone Healthcare Group Phoenix AZ

Health Plan LPN Notice Of Action

Banner Health