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Prior Authorization Referrals & Notifications Representative
Location
United States
Posted
7 days ago
Salary
Not specified
No structured requirement data.
Job Description
Role Description
As a Prior Authorization Referrals & Notifications Representative with Banner Plans & Networks, you will call upon your medical office and/or medical prior authorizations experience to help members and work as part of a larger team. You will perform data entry, review regulatory guidelines, and answer a phone queue on a rotating basis.
Your work shifts will be Monday-Friday with a Saturday rotation every 4 weeks. Your work location will be remote. For compliance, for this role, you must live within 30 minutes of driving distance to Banner Mesa Corporate Center in Mesa, Arizona or Banner Corporate Center in Tucson, Arizona.
Under the direction of the Prior Authorization leader, the primary purpose of this position is to perform non-clinical functions related to Prior Authorization requests and notifications.
Core Functions
- Review all requests for authorization for eligibility, expiration date, accuracy and completeness.
- Data enters all member information in documentation database using approved notification templates to meet regulatory requirements.
- Enters all approvals, extensions, downgrades, 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.
- Performs other related duties as assigned, which are consistent with the goals and qualifications of this position.
- 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.
- 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.
Qualifications
- Strong knowledge of medical terminology.
- Knowledge of HMO systems.
- Experience working with the medical referral/denial process (normally gained through two years of experience in a medical office or clinical environment).
- Ability to work independently.
- Ability to work with database systems.
- Good working knowledge of PC applications.
Preferred Qualifications
- Additional related education and/or experience preferred.
EEO Statement
EEO/Disabled/Veterans. Our organization supports a drug-free work environment.
Privacy Policy
Privacy Policy
Job Requirements
- Strong knowledge of medical terminology.
- Knowledge of HMO systems.
- Experience working with the medical referral/denial process (normally gained through two years of experience in a medical office or clinical environment).
- Ability to work independently.
- Ability to work with database systems.
- Good working knowledge of PC applications.
- Preferred Qualifications
- Additional related education and/or experience preferred.
- EEO Statement
- EEO/Disabled/Veterans. Our organization supports a drug-free work environment.
- Privacy Policy
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