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. Apply tot his job