This position is forCare1st Health Plan in Phoenix, a WellCare Healthplans, Inc. company.
Coordinates the Notice of Action (NOA) process for all denials for all Care1st lines of business. Ensures all State and Federal Regulations and NCQA Guidelines are met in the policies and letters.
Reports to: Mgr, Operations
Location: Camelback Rd, Phoenix AZ 85016
Job Type: Hourly/Non-exempt
- Writes NOA letters with appropriate language level for the member's line of business and works with Medical Management staff to meet regulatory requirements for NCQA, State, Federal, and Regulatory agencies.
- Coordinates, documents, and tracks all denials in appropriate systems.
- Ensures that the appropriate policies and procedures are updated, meeting State and Federal regulations and performs research to stay up-to-date with State and Federal regulations.
- Participates in peer review process and quarterly NOA audits.
- Ensures NOA's meet all regulatory timeframes across the team.
- Develops and maintains logs, files, and tracking systems for all denials.
- Maintains and prepares a monthly denial report for all denials for all lines of business.
- Keeps management informed when a specific part of the NOA Process is out of compliance.
- Performs other duties as assigned.
- Required A High School or GED
- Required 2 years of experience in Medical Office or related health plan experience
- Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
- Intermediate Ability to work within tight timeframes and meet strict deadlines
- Intermediate Demonstrated problem solving skills
- Intermediate Demonstrated written communication skills
Licenses and Certifications:
- A Certified Medical Assistant (CMA) license is preferred.
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Outlook
- Required Beginner Microsoft Excel