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Notice of Action (Denial) Technician (AZ Remote)

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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 buildingPlease 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.This position is remote/ within the state of AZ onlyPURPOSE OF THE JOBThe Prior Authorization/Pharmacy Denial Technician processes non-certified prior authorization medical and pharmacy requests, according to Medicaid Business Segment and contractual policies and procedures and completes required documentation within established timeframes.QUALIFICATIONSREQUIRED QUALIFICATIONS1. Required Work Experience· 1 year of Medicare, Medicaid or Managed Care experience· 1 year of experience in any of the following: medical/dental office, call center, pharmacy2. Required Education· High-School Diploma or GED in field of study3. Required LicensesPREFERRED QUALIFICATIONS1. Preferred Work Experience· N/A4. Required Certifications· N/A2. Preferred Education· High School Diploma or equivalent3. Preferred Licenses· N/A4. Preferred Certifications· Completion of Medical Assistant or Pharmacy Technician programESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIESProcess 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 but not limited to: 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· The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.· Perform all other duties as assignedCOMPETENCIESREQUIRED COMPETENCIES1. Required Job Skills· N/A2. Required Professional Competencies· N/A3. Required Leadership Experience and Competencies· N/APREFERRED COMPETENCIES1. Preferred Job Skills· N/A2. Preferred Professional Competencies· N/A3. Preferred Leadership Experience and Competencies· N/AOur CommitmentAZ 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.Apply Job! 

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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