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Prior Authorization Associate Jobs in Arizona (NOW HIRING)

La Frontera Center Inc.

Recovery Coach - Children

Tucson, AZ · On-site

$14.75 - $19.25/hr

Obtain appropriate prior authorization of inpatient, partial hospitalization, residential and other ... Associate's degree and two years of behavioral health work experience High school diploma or high ...

La Frontera Center Inc.

Recovery Coach

Tucson, AZ · On-site

$14.75 - $19.25/hr

Obtain appropriate prior authorization of inpatient, partial hospitalization, residential and other ... Associate's degree and two years of behavioral health work experience High school diploma or high ...

SMI IMAGING LLC

Pre-Authorization Representative

Phoenix, AZ · On-site

$39K - $54K/yr

Obtains pre-certification and registration prior to a patient's appointment. * Gathers pertinent ... Requires an associate's degree or its equivalent and 2-4 years of experience. PHYSICAL DEMANDS:

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Prior Authorization Associate information

What is the difference between Prior Authorization Associate vs Medical Billing Specialist?

AspectPrior Authorization AssociateMedical Billing Specialist
CredentialsHigh school diploma or equivalent; certification in medical billing or coding often preferredHigh school diploma or equivalent; certification in medical billing or coding often preferred
Work EnvironmentHealthcare offices, insurance companies, hospitalsHealthcare offices, billing companies, hospitals
Primary ResponsibilitiesObtain prior authorizations from insurance for procedures and treatmentsProcess and submit medical claims, handle billing and payments

The main difference is that a Prior Authorization Associate focuses on securing insurance approvals before procedures, while a Medical Billing Specialist manages the billing process after services are rendered. Both roles require similar credentials and often work in healthcare settings, but their core functions differ in the patient care and revenue cycle process.

What jobs pay 2000 a day?

Jobs that pay around $2,000 a day typically include high-level roles such as specialized medical professionals, senior corporate executives, or certain consulting and legal positions. These roles often require advanced skills, extensive experience, or professional certifications, and may involve high-pressure environments or significant responsibility.

What jobs in the US pay 300,000 a year?

Prior Authorization Associates typically do not earn $300,000 annually, as this salary level is uncommon for roles focused on administrative and insurance authorization tasks. High-paying jobs in the US that reach or exceed this level often include specialized medical professionals, executive roles, or certain technology and finance positions that require advanced skills, certifications, or extensive experience.

What are the key skills and qualifications needed to thrive as a Prior Authorization Associate, and why are they important?

To thrive as a Prior Authorization Associate, you need a strong understanding of medical terminology, insurance processes, and prior authorization requirements, often backed by a high school diploma or associate degree. Familiarity with healthcare management software, electronic health record (EHR) systems, and payer portals is typically required. Excellent attention to detail, organizational skills, and effective communication are essential soft skills for this role. These skills ensure timely and accurate processing of prior authorizations, minimizing delays in patient care and supporting efficient healthcare operations.

What job makes $10,000 a month without a degree?

A Prior Authorization Associate typically earns between $3,000 and $6,000 per month, so earning $10,000 monthly without a degree is uncommon in this role. High-paying jobs that can reach this level often involve specialized skills, certifications, or experience in fields like sales, real estate, or entrepreneurship. Some self-employed or commission-based roles may also achieve this income without formal degrees.

Is prior authorization a stressful job?

Prior Authorization Associates often work in fast-paced healthcare environments, managing multiple requests and deadlines, which can be stressful. The role requires attention to detail, communication skills, and familiarity with insurance policies, which can contribute to job-related stress levels.

What are Prior Authorization Associates?

Prior Authorization Associates are professionals who handle the process of obtaining approval from insurance companies before certain medical services, procedures, or medications are provided to patients. They review clinical documentation, communicate with healthcare providers and insurers, and ensure all necessary information is submitted for timely authorization. Their work helps reduce claim denials and ensures patients receive the care they need while adhering to insurance requirements.

What are some common challenges faced by a Prior Authorization Associate, and how can they be effectively managed?

Prior Authorization Associates often encounter challenges such as navigating complex insurance requirements, handling high volumes of authorization requests, and managing tight turnaround times. Staying organized, keeping up-to-date with payer policies, and using robust tracking systems can help manage these difficulties. Collaborating closely with clinical staff and insurance representatives is also essential for resolving issues quickly and ensuring approvals are processed efficiently. Developing strong communication and problem-solving skills is key to success in this role.
What are the most commonly searched types of Prior Authorization jobs in Arizona? The most popular types of Prior Authorization jobs in Arizona are:
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Prior Authorization Associate jobs near you
Medical Appeals and Grievance (MAG) Registered Nurse Specialist II - Remote

Medical Appeals and Grievance (MAG) Registered Nurse Specialist II - Remote

Blue Cross Blue Shield of Arizona

Phoenix, AZ • Hybrid

Full-time

Medical

Posted 8 days ago

Blue Cross Blue Shield Of Arizona rating

6.0

Company rating: 6.0 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

244th of 263 rated insurance

Job description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa 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 twice per week

  • Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within 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 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 building

Please 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 week.

This position is remote within Arizona or in an approved out-of-state location. Applicants must reside in-and perform work from-the state of Arizona or an approved out-of-state location.

Purpose of the job

Responsible for utilizing clinical acumen and managed care expertise related to researching, resolving and responding to requests for member and provider appeals, grievances, reconsiderations and corrected claims for all lines of business with emphasis on privacy, accuracy, meeting all regulatory and compliance timelines.

Qualifications

REQUIRED QUALIFICATIONS

Required Work Experience
Level 1

  • 1 year Experience in clinical and health insurance or other healthcare related field

Level 2

  • 3 years' Experience in clinical and health insurance or other healthcare related field
  • 1 year' Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)

Level 3

  • 5 years' Experience in clinical and health insurance or other healthcare related field
  • 2 years Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)

Level 4

  • 8 years' Experience in clinical and health insurance or other healthcare related field
  • 3 years' Above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)

Required Education

  • Associate's Degree in a healthcare field of study or Nursing Diploma (Applies to All Levels)

Required Licenses

  • Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) or a compact state as a Registered Nurse (RN)

Required Certifications

  • N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience
Level 1

  • 3 years' Experience in clinical and health insurance or other healthcare related field. Working knowledge of eviCore, MCG, McKesson InterQual criteria and Medical Coverage Guidelines/Medical Policies. Advanced ability to interpret contract language and benefits

Level 2

  • 5 years' Experience in clinical and health insurance or other healthcare related field. Working knowledge of eviCore, MCG, McKesson InterQual criteria and Medical Coverage Guidelines/Medical Policies. Advanced ability to interpret contract language and benefits
  • 2 years' Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)

Level 3

  • 7 years' Experience in clinical and health insurance or other healthcare related field. Working knowledge of eviCore, MCG, McKesson InterQual criteria and Medical Coverage Guidelines/Medical Policies. Advanced ability to interpret contract language and benefits
  • 5 years' Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)

Level 4

  • 9 years' Experience in clinical and health insurance or other healthcare related field. Working knowledge of eviCore, MCG, McKesson InterQual criteria and Medical Coverage Guidelines/Medical Policies. Advanced ability to interpret contract language and benefits
  • 5 years' Above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)

Preferred Education

  • Bachelor's Degree in Nursing or related field of study (Applies to All Levels)

Preferred Licenses

  • N/A

Preferred Certifications

  • N/A
ESSENTIAL job functions AND RESPONSIBILITIES

Level I

  • Perform in-depth analysis, clinical review and resolution of provider appeals/inquiries, corrected claims and subscriber reconsiderations, member appeals, corrected claims and provider grievances for all lines of business
  • Identify, research, process, resolve and respond to customer inquiries primarily through written / verbal communication.
  • Respond to a diverse and high volume of health insurance appeal related correspondence on a daily basis.
  • Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of appeal, grievance and reconsideration requests.
  • Maintain complete and accurate records per department policy.
  • Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
  • 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 resolution of customer inquiries.
  • Attend staff and interdepartmental meetings.
  • Participate in continuing education and current developments in the fields of medicine and managed care.
  • Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements.
  • Maintain productivity and accuracy goals based on regulatory requirements, accreditation standards, and service level agreements.
  • Demonstrate ability to acquire specialized knowledge to complete all types of level one appeals, grievances and corrected claims for local lines of business using appropriate benefit plan booklet, administrative guidelines and policies, medical criteria guidelines, claims research, provider contracts and fee schedules, communication records research and precertification research.
  • Articulate to customers a variety of information about the organization's services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, and provider networks.
  • Adheres to BCBSAZ brand promise of being a "Trusted Advisor" by walking in the customers shoes including processing work using the principles of easy, effective, emotional

level II

  • Ability to demonstrate specialized knowledge to administer Federal Employee Program (FEP)inquiries, appeals, grievances and sub-reconsiderations using appropriate service benefit plan provisions, and internal policies, medical criteria guidelines, claims research, provider contracts and fee schedules, communication records research, and precertification research.
  • Ability to demonstrate specialized knowledge to perform reviews for local lines of business, Blue Card Home member appeals and grievances, and Blue Card Host provider grievances. MAG Clinicians also support FEP for member reconsiderations, provider appeals, corrected claims and inquiries.

level III

  • Ability to demonstrate specialized knowledge to complete all Levels of Medical Appeals and Grievance (MAG) cases (Initial internal, voluntary internal and external review appeals and grievances).
  • Under minimal direction, lead interdepartmental meetings and oversee special projects as assigned.
  • Assist in developing new policies and procedures, desk levels, and job aids as needed.
  • Assist in training new staff and provide ongoing training for existing staff as needed.
  • Assist in distribution of staff Flow Manager case assignments.
  • Identify and recommend process improvements.


level IV

  • Assist in distribution of staff case assignments.
  • Under minimal direction, prepare reports and documentation for committee presentation and ad hoc reports as needed.
  • Analyze appeals and grievances data and make recommendations based on trends identified.
  • Take initiative to follow through on issues and opportunities for process improvements.
  • Initiate, develop and implement in-service educational presentations.
  • Work collaboratively with management and provide leadership for the department in day to day activities as well as in management's absence.
  • Maintain a working knowledge of all activities in the department and provide assistance to departmental staff and interdepartmental staff as necessary.
  • Consistently demonstrate alignment with the BCBSAZ "Living our Values" culture by participating in annual, community service campaigns and/or projects such as, CARES Club, United Way and/or community wellness initiatives (Walk for Hope, Walk to Stop Diabetes, Phoenix Heart Walk, etc).


ALL LEVELS

  • Each progressive level includes the ability to perform the essential functions of any lower levels.
  • 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 assigned
competencies

REQUIRED COMPETENCIES

Required Job Skills

  • Intermediate PC proficiency (All Levels)
  • Intermediate skill using office equipment, including copiers, fax machines, scanner and telephones (All Levels)

Required Professional Competencies

  • Maintain confidentiality and privacy
  • Advanced clinical knowledge
  • Practice interpersonal and active listening skills to achieve customer satisfaction
  • Compose a variety of business correspondence
  • Interpret and translate policies, procedures, programs and guidelines
  • Capable of investigative and analytical research
  • Navigate, gather, input and maintain data records in multiple system applications
  • Follow and accept instruction and direction
  • Establish and maintain working relationships in a collaborative team environment
  • Organizational skills with the ability to prioritize tasks and work with multiple priorities under limited time constraints
  • Independent and sound judgment with good problem solving skills
  • Ability to assist in training of new and existing staff (Applies to Levels 3 and 4)

Required Leadership Experience and Competencies

  • Ability to revise departmental policies and procedures and desk levels as well as develop new policies and procedures and desk levels as needed (Applies to Levels 3 and 4)
  • Proven leadership and assistance through positive reinforcement of processes and company policies
    (Applies to Levels 3 and 4.)

PREFERRED COMPETENCIES

Preferred Job Skills

  • Advanced PC proficiency
  • Knowledge of Current CPT, ICD- 9, ICD-10, HCPCS, and DRG coding

Preferred Professional Competencies

  • Working knowledge of McKesson InterQual criteria and Medical Coverage Guidelines/Medical Policies
  • Advanced ability to interpret contract language and benefits

Preferred Leadership Experience and Competencies

  • N/A

Our Commitment

AZ 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.

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