Job Description

The Prior Authorization Technician processes written and telephone requested services by providers for Health Choice members within established timeframes, following Health Choice criteria and guidelines. This position also completes data entry and provider notification to ensure timely service to members and answers a high volume of calls within contract-mandated timeframes.

 
Answer prior authorization/pharmacy calls:
* Log into phone queue to service providers
* Answer inbound calls regarding authorizations within established time frame
* Document contact information in electronic medical record system
* Maintain productivity
* Handle calls professionally
* Provide accurate prior authorization information to provider offices


Review prior authorization requests:
* Review and approve requests based on Health Choice established guidelines
* If determination is not made, forward prior authorization request to Supervisor/Manager
* Contact referring provider to obtain additional information needed to make determination
* Fax decisions to requesting providers
* Prepare member denial letters following final decision of Medical Director
* Enter appropriate authorizations and notify provider of approval
* Document criteria met in electronic medical record system
* Complete processing within established timeframes


Assist other departments with Prior Authorization needs:
* Assist Utilization Review Nurses with obtaining authorizations and coordinating care for discharge planning, forward appropriate referrals to case management.
* Enter authorizations for nurses for discharge care
* Set up transportation upon discharge
* For after hours staff, enter data regarding newborn babies into the AHCCCS website.


Provide ongoing education and training to physician’s offices and facilities:
* Inform offices of any updated or changed policies and procedures
* Ensure all physicians and facilities are educated on proper authorization procedures and updated prior authorization guidelines

 

Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled


 



Qualifications

Qualifications:

High School Diploma or GED

Completion of Medical Assistant program preferred

Previous experience in a call center
Knowledge of medical terminology
Computer experience necessary
Effective interpersonal and communication skills, especially telephone skills
Strong customer service skills
Ability to use electronic medical record and claims systems
Work cooperatively, positively, and collaboratively in an interdisciplinary team
Work respectfully and positively with providers and members
Ability to prioritize work tasks to adhere to deadlines and identified time frames

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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