Notice of Action (Denial) Technician (AZ Remote)

About the position

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 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.

Requirements

• 1 year of Medicare, Medicaid or Managed Care experience.
• 1 year of experience in a medical/dental office, call center, or pharmacy.
• High School Diploma or GED.

Nice-to-haves

• Completion of Medical Assistant or Pharmacy Technician program.