Prior Authorization Technician - Medicaid

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least once per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per month.

PURPOSE OF THE JOB

The Prior Authorization Technician processes written requested services by providers for Medicaid Business Segment members within established timeframes, following Medicaid Business Segment criteria and guidelines. This position also completes data entry and provider notification to ensure timely service to members.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

· 1 year of experience in effectively using interpersonal communication skills, especially via telephone

· 1 year of experience using electronic Care Management systems

2. Required Education

· High School Diploma or GED in general field of study

3. Required Licenses

· N/A

4. Required Certifications

· N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

· 1-2 years Prior Call Center experience preferred

· 1-2 years Medicaid/Medicare experience preferred

· 1-2 years Prior Managed Care experience preferred

2. Preferred Education

· Completion of Medical Assistant program

3. Preferred Licenses

· N/A

4. Preferred Certifications

· N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

· Answer inbound calls regarding authorizations within established time frame

· Document contact information in electronic care management system

· Ensure all necessary information is entered in electronic care management system

· Review and approve requests based on Medicaid Business Segment established guidelines

· Ensure requests are forwarded to correct location according to established review process

· Contact referring provider to obtain additional information needed to make determination

· Fax decisions to requesting providers

· Provide education to providers and facilities regarding proper authorization procedures and inform them of any updates as needed

· Initiate interdepartmental coordination to ensure quality and timely care for members.

· Additional duties as assigned

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

· Knowledge of medical terminology

· Computer experience necessary

2. Required Professional Competencies

· N/A

3. Required Leadership Experience and Competencies

· N/A

PREFERRED COMPETENCIES

1. Preferred Job Skills

· N/A

2. Preferred Professional Competencies

· N/A

3. Preferred Leadership Experience and Competencies

· N/A

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona.  For more information on our company, see azblue.com.  If interested in this position, please apply.