Address
Form of workPrimary City/State:
Arizona, ArizonaDepartment Name:
Prior AuthorizationWork Shift:
DayJob Category:
General OperationsGreat options and great opportunities. At Banner we are tapestry of cultures, and experiences. A workforce that is honored to serve, and support the community. If you’re looking to leverage your abilities – you belong at Banner Health.
Banner Health has been recognized by Becker’s Healthcare as one of the 150 top places to work in health care. In addition, we recently made Newsweek’s list of America’s Greatest Workplaces 2023 for Diversity. These recognitions reflect Banner Health's investment in team members' professional development, wellness benefits, and continued education. It highlights our commitment to advocating for diversity in the workplace, promoting work-life balance, and boosting employee engagement.
As a Prior Authorization Referrals and Notifications Representative, you will utilize your background medical terminology and medical referrals to be an important member of the Banner Plans & Networks Team. You will complete data entry and be in a rotating que for calls regarding referrals questions.
You will work primarily in a remote setting. Residency in, or near, the Mesa, Arizona or Tucson, Arizona Metropolitan Areas is required. This residency is required in case emergent needs arise to come into the corporate offices. Your work week will primarily be Monday-Friday with a Saturday rotation every four months. Your work shift will be 8:00 a.m. - 5:00 p.m. Arizona Time Zone. If this role sounds like the one for you, Apply Today!
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 Prior Authorization leader, the primary purpose of this position is to perform non-clinical functions related to Prior Authorization requests and notifications.
CORE FUNCTIONS
1. Review all requests for authorization for eligibility, expiration date, accuracy and completeness.
2. Data enters all member information in documentation data base. Uses approved notification templates to meet regulatory requirements.
3. Enters all approvals, extensions, downgrades, 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. Performs other related duties as assigned, which are consistent with the goals and qualifications of this position.
7. 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.
8. 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
Required for successful performance in this position is strong knowledge of medical terminology, knowledge of HMO systems and experience working with the medical referral/denial process. This knowledge is normally gained through two years of experience in medical office or clinical environment.
Ability to work independently is required, as is the ability to work with data base systems and good working knowledge of PC applications.
PREFERRED QUALIFICATIONS
Additional related education and/or experience preferred.
Microsoft Office Advanced Skills
EOE/Female/Minority/Disability/Veterans
Our organization supports a drug-free work environment.
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