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