Notice of Action

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.

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

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 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

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 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.