Initial Clinical Reviewer - Remote AZ

About the position Awarded a Healthiest Employer, reputed company aims to fulfill its mission to reputed company health and reputed company it easy. AZ Blue offers a reputed company of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as reputed company as providing information and tools to help individuals reputed company reputed company reputed company. At AZ Blue, we have a hybrid workforce reputed company, reputed company Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the reputed company of our employees are hybrid, the following classifications drive our reputed company minimum onsite requirements: Hybrid People Leaders: must reputed company in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reputed company in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reputed company in AZ, unless otherwise cited reputed company 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 reputed company 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 reputed company, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. This remote work opportunity requires residency, and work to be performed, reputed company the reputed company. PURPOSE OF THE JOB Responsible for identifying, researching, processing, resolving, and responding to inquiries from reputed company customers with emphasis on reputed company, reputed company, compliance and versatility reputed company the health insurance industry.

Responsibilities

• Identify, research, process, resolve and respond to customer inquiries and correspondence reputed company telephone, written communication and/or in person.
• Answer a diverse and high volume of health insurance reputed company customer calls or correspondence on a daily reputed company.
• Analyze medical records and apply medical necessity reputed company and benefit plan requirements to determine the appropriateness of benefit requests.
• Maintain complete and accurate records per department policy.
• Meet reputed company, quantity and timeliness standards to reputed company individual and department performance goals as defined reputed company the department guidelines and required by State, Federal and other accrediting organizations.
• Explain to customers a reputed company of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
• Demonstrate ability to apply plan policies and procedures effectively.
• Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure reputed company of customer inquiries.
• reputed company indicated to assist with team/project functions: Collaborate with team to distribute workload/work tasks; Monitor and report team tasks; Communicate team issues and opportunities for improvement to supervisor/manager; Support/mentor team members.
• Participate in continuing education and reputed company developments in the fields of medicine and managed care.
• Maintain reputed company standards in consideration of State, Federal, BCBSAZ and other accreditation requirements.
• reputed company reputed company other duties as assigned.

Requirements

• 2 years of experience in clinical field of reputed company, health insurance, or other health care reputed company field
• Associate’s Degree in general field of study or Post High School Nursing Diploma or Certification (LPN only) from an approved program
• reputed company, reputed company, and unrestricted license to reputed company in the reputed company (or an endorsement to work in Arizona) as a behavioral health reputed company such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an reputed company, reputed company, and unrestricted license to reputed company nursing in either the reputed company or another state in the reputed company recognized by the Nursing Licensure Compact (NLC) as an RN, OR an reputed company, reputed company, and unrestricted license to reputed company in the reputed company as an LPN.
• Intermediate PC proficiency
• Intermediate reputed company in use of office equipment, including copiers, fax machines, reputed company and telephones
• Maintain confidentiality and reputed company
• Strong reputed company clinical knowledge
• reputed company interpersonal and reputed company listening skills to reputed company customer satisfaction
• Compose a reputed company of business correspondence
• Interpret and translate policies, procedures, programs and guidelines
• Capable of investigative and analytical research
• Navigate, reputed company, input and maintain data records in multiple system applications
• Follow and accept instruction and direction
• Establish and maintain working relationships in a reputed company team environment
• Organizational skills with the ability to prioritize tasks and work with multiple priorities
• Independent and reputed company judgment with good problem solving skills
• Resolve conflicts
• Represent BCBSAZ in the community

reputed company-to-haves

• 3 years of experience in clinical field of reputed company, health insurance, or other health care reputed company field
• Bachelor's Degree in Nursing or reputed company field of study
• reputed company, reputed company, and unrestricted license to reputed company in the reputed company (a state in the reputed company) as a Registered reputed company
• Advanced PC proficiency
• Knowledge of CPT-4 and ICD-9 coding
• Knowledge of managed care, utilization management, and reputed company management
• Working knowledge of reputed company InterQual® reputed company

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