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The Notice of Action (NOA) department is completely compliance driven, in that AHCCCS (Medicaid) and Medicare create the rules of how this department is to be operated. The LPN will assist with writing and sending denial letters to update members through the benefit process. They work very closely within our prior authorization department, and will have no direct patient contact.
Active unrestricted AZ LPN license permitting work in the State of Arizona.
In office, and opportunities for on-call rotation
Banner Corporate Center-Mesa
525 West Brown RD.
Mesa, AZ 85201
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
About University Physicians Health Plans
The University of Arizona Health Plans (UAHP) manage a variety of health plans. Our mission is to advance health and wellness through education, research and patient care.
About Banner Health
Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.
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.