NOA Team Coordinator

Summary

Under the direction of the Supervisor, NOA Team, the NOA Team Coordinator’s primary responsibility is to prepare and process Notice of Action notification letters for managed care members.

Duties and Responsibilities:

• Prioritizes and reviews Red Flag report for turn-around times
• Check the notes from Medical Director and Nurses for medical necessity or benefit coverage
• Check previous authorizations, claims and notes, back history etc.
• Verify that the proper criteria was cited based on hierarchy and LOB for the denial/modification using each health plan’s E.O.C. and/or Medi-Cal, CMS matrixes for benefits and evidence based guidelines for medical necessity
• Compose all written Notice of Action letters according to MPM Policies and meet all NCQA, Health Plan, Federal and State requirements of appropriate mandated grade levels
• Ensure Diagnosis, denial/modification rationale, criteria cited and denial/modification verbiage correspond
• Ensure denial/modification verbiage has been reviewed prior to finalizing
• Process Notice of Action letters through sPHERICAL Solutions
• Compile denial/modification packets
• Must work Saturday or Sunday in lieu of one weekday

Minimum Job Requirements:

• High school diploma or GED
• 1 year experience in a medical office
• 1 year experience in Utilization Management
• Completion of medical terminology class
• Proficiency in Microsoft Office (Word, Excel, etc.)

Skills and Abilities:

• Strong organizational skills, with the ability to multitask
• Excellent communication and customer service skills
• Ability to handle sensitive matters with professional discretion
• Positive attitude and flexibility, a must