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Licensed Practical Nurse Lpn Health Plan Notice Of Action Remote
Company | Banner Health |
Address | , Phoenix, 85012, Az |
Employment type | FULL_TIME |
Salary | |
Expires | 2023-07-24 |
Posted at | 10 months ago |
Primary City/State:
Phoenix, ArizonaDepartment Name:
Prior AuthorizationWork Shift:
DayJob Category:
General OperationsA rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options. If you’re looking to leverage your abilities – you belong at Banner Health.
In this position of - Health Plan Licensed Practical Nurse, HP LPN Notice of Action, you will write denial letters based on Prior Authorization Nurse, Pharmacy, and Behavioral Health reviews. Once denied by the appropriate professional, you will write these up in an 8th grade reading level for Medicare members or a 6th grade level for Medicaid members. Hours for this remote position are
Monday – Friday 8AM – 5PM and will be added to the Saturday rotation when orientation is complete.
Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits.
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.POSITION SUMMARY
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.
CORE FUNCTIONS
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.
MINIMUM QUALIFICATIONS
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.
PREFERRED QUALIFICATIONS
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.
EOE/Female/Minority/Disability/Veterans
Our organization supports a drug-free work environment.
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