Licensed Practical Nurse

Work at Home
Immediate

Job Description

BroadPath is hiring a Licensed Practical Nurse (LPN) to work from home! LPN's will review health plan denials for eligibility, expiration date, accuracy and completeness and create letters of denial for health plan members. The primary purpose of this position is to process all Notices of Action (NOA) and Notices of Non-Medical Coverage (NOMNC) for services accurately and in a timely manner.

Responsibilities

  • Reviews all health plan denials for eligibility, expiration date, accuracy and completeness
  • Writes all member information in AHCCCS/SNP approved NOA/NOMNC templates to meet regulatory requirements
  • Enters all denials/partial denials/service reductions into the computer systems
  • Performs other related duties, consistent with the goals and qualifications of this position
  • Works cooperatively with both internal and external customers in assisting members and providers with referral related issues
  • Call rotation for the health plan, as well as departmental call rotation for holidays
  • Meets internal and external customer service expectations regarding duties and professionalism
  • This position performs all related duties in a manner that is consistent with and in support of the organization's mission, vision, values and goals
  • This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service

Basic Qualifications

  • Current, unrestricted AZ LPN license permitting work in the State of Arizona
  • A minimum of three years’ experience in an acute care setting
  • At least two years of experience in prior authorization or utilization management, knowledge of insurance, managed care principles, and community facilities and resources
  • Proficient on a computer (PC) with Microsoft Office Products. Ability to work with databases/programs, such as IDX and ability to work independently, with analytical, problem solving, decision making, concurrent and retrospective data management skills are necessary
  • Working knowledge of medical terminology and coding (ICD-9, CPT-4) is required

Preferred Qualifications

  • Case Management experience preferred
  • Experience specific to ICU/Med. Surg. and knowledge of Arizona Health Care Cost Containment System (AHCCCS) and Centers for Medicare and Medicaid Services (CMS) regulations preferred
  • Knowledge of AHCCCS, CMS and regulatory requirements and working knowledge of clinical criteria such as Milliman Care Guidelines is preferred