Prior Authorization Referral and Notifications Representative

Banner Health•Mesa, AZ

3d•Remote

About The Position

Banner Plans & Networks (BPN) is an integrated network for Medicare and private health plans. Known nationally as an innovative leader, BPN insurance plans and physicians work collaboratively to keep members in optimal health while reducing costs. Supporting our members and vast network of providers is a team of professionals known for innovation, collaboration, and teamwork. If you would like to contribute to this leading-edge work, we invite you to bring your experience and skills to BPN. 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 que 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. If this role sounds like the one for you, Apply today! Banner Plans & Networks (BPN) 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 BPN, 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.

Requirements

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.

Nice To Haves

Additional related education and/or experience preferred.

Responsibilities

Review all requests for authorization for eligibility, expiration date, accuracy and completeness.
Data enters all member information in documentation data base. Uses 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.