Prior Authorization Specialist I - Intermittent - Medicaid Travel Office - $17.60 - $ 21.54/hr


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If you cannot find the positng feel free to email us at QCCCManagement@anthc.org 

Job Description

Under supervision, screen patient eligibility and assess clinical information, referred patients to determine eligibility for State of Alaska Medicaid Travel Benefits. Assist the patient, clinic and service unit with successful evaluation and submission for patient travel benefits.
The following duties are intended to provide a representative summary of the major duties and responsibilities and ARE NOT intended to serve as a comprehensive list of all duties performed by all employees in this classification. Incumbent(s) may not be required to perform all duties listed and may be required to perform additional, position-specific duties. Level I employees perform work under close supervision, may only perform simple or routine aspects or the position, and generally require a good deal of instruction and/or training. Level III employees perform high level, complex, and responsible tasks within this position, train lower level employees, and generally work with minimum supervision and follow-up from their supervisor.


REPRESENTATIVE DUTIES
All
Conducts clinical evaluations of documentation provided by the patient, ANMC, and healthcare entities to determine eligibility for patient travel benefits under the rules and regulations of the Alaska State Medicaid


Program. Serves as the liaison between the patient, ANMC and the State of Alaska regarding Medicaid Transportation Services to prove medical necessity for a Medicaid Travel Authorization.


Must be able to communicate effectively with patients and various healthcare professional providing updates on authorization information and required documents needed to be sent to the State of Alaska. Gathers all information requested by the Alaska State Medicaid Representative by utilizing various computer systems and by communicating with ANMC or Tribal Health Partner RN Case Managers. Informs customers about other services and resources that are available to them.


Works collaboratively with other members of the team and departments, as well as outside agencies, to ensure the State of Alaska Rules and Regulations are being met while also serving as an advocate for the patient and referring provider. Will determine continued or amended eligibility in real time with all tribal travel agencies and relative accommodations.


Ensure that there is accurate documentation to prove the medical necessity of the travel authorization.


All submitted authorizations should reflect the correct CPT and diagnosis codes. All authorizations numbers should be reflective of the dates authorized and should correspond to the services authorized.


Coordinate with or assume the function of Prior Authorization, Provider Inquiry, and Claims Resolution units to ensure provider/claims resolution.
Analyze findings and advise supervisor of significant system or provider problems/concerns, work aged or
other associated production reports as well as all State entities involved with provider claims.
Performs other duties as assigned or required.


Prior Authorization Specialist III
Proficient working knowledge of ANMC Operator Switchboard, Alaska Medicaid Rules and Regulations,
ANMC Prior Authorization Process, ANMC Travel Management process and knowledge of Tribal Health
Organizations and service units.
Ability to train individuals in Travel Management Office processes and support leadership functions.
Performs other duties as assigned or required.

Required Skills

 Knowledge of Alaska Tribal Health System, ANTHC, and Alaska Native culture(s).
 Knowledge of alternative health resources.
 Knowledge of customer service concepts and practice.
 Knowledge of basic medical terminology, abbreviations, ICD 10 Coding and clinic systems.
 Knowledge of the Privacy Act of 1974 and HIPAA Privacy Rule Act of 1966.
 Knowledge of state, federal, and tribal health care programs.
 Knowledge of state, federal and public/private insurance, including Medicaid/Medicare.


 Skill in accuracy with data entry and the ability to make detailed notes
 Skill in working independently or as a team member.
 Skill in dealing with distressed customers.
 Skill in grammar, spelling, sentence structure and effective business letter writing.
 Skill in operating office equipment, including copiers and fax machines.
 Skill in interpreting state, federal, and public/private insurance financing.
 Skill in oral and written communication.
 Skill in managing multiple priorities and tasks concurrently and meeting deadlines.
 Skill in establishing and maintaining cooperative working relationships with others.
 Skill in operating a personal computer utilizing a variety of applications.

Required Experience

MINIMUM EDUCATION QUALIFICATION


Prior Authorization Specialist I & II
A high school diploma or GED equivalent.


Prior Authorization Specialist III
Associates Degree in Business or related field. Progressively responsible medical billing, accounting or
related work may be substituted on a year-by-year basis for the college education.


MINIMUM EXPERIENCE QUALIFICATION


Prior Authorization Specialist I
Non-supervisory – One (1) year of Alaska Medicaid experience AND two (2) years of customer centric
experience. An equivalent combination of relevant education and/or training may be substituted for
experience.


Prior Authorization Specialist II
Non-supervisory –Two (2) years of Alaska Medicaid experience AND two (2) years of customer centric OR
one (1) year working for ANMC Travel Management Office as a Prior Authorization Specialist I. An
equivalent combination of relevant education and/or training may be substituted for experience.
AND
Must have successfully mastered Two (2) of the following areas of PA Duties:
 Alaska Medicaid Rules and Regulations
 Tribal Travel vs. Medicaid eligible travel
 Navigate document in Alaska Medicaid, State and ANMC software applications
 Eligibility Determination and appropriate screening


Prior Authorization Specialist III
Non-supervisory – Three (3) years customer centric experience AND two (2) years of Alaska Medicaid
experience OR Three (3) years working for ANMC Travel Management Office as a Prior Authorization
Specialist II. An equivalent combination of relevant education and/or training may be substituted for
experience.
AND
Must have successfully mastered all the following areas of PA duties:
 Alaska Medicaid Rules and Regulations
 Tribal Travel vs Medicaid eligible travel
 Navigate and document in Alaska Medicaid, State and ANMC software applications
 Eligibility determination and appropriate screening
 Working knowledge of the ANMC Patient Travel Agent, Purchased Referred Care Travel Agent and
Care Coordination Agent


MINIMUM CERTIFICATION QUALIFICATION
N/A


PREFERRED EDUCATION QUALIFICATION
N/A


PREFERRED EXPERIENCE QUALIFICATION
 Basic computer, software applications and data entry experience


PREFERRED CERTIFICATION QUALIFICATION
N/A


ADDITIONAL REQUIREMENTS
All
• Will need to be able to work weekend shifts and holidays.


Prior Authorization Specialist III
• Will need to be able to take call on a rotating schedule.


WORKING CONDITIONS


The following demands are representative of those that must be met by an employee to successfully
perform the essential functions of this job:


 Must be able to lift approximately 50 pounds.
 ANMC is not a latex free facility; an employee should expect to work in an environment where latex
may be present.
 Ability to stand, walk or sit for varied periods of time.
 May also be required to bend, twist and reach. May be occasionally exposed to infectious diseases.
 May be required to work outside the traditional work schedule.
 May be called out to work off-shift in emergency situations.
This job description is not an employment agreement or contract. Management has the exclusive right to
alter this job description at any time without notice.

Job Location

Anchorage, Alaska, United States

Position Type

PRN

Anchorage, AK

6 day(s) ago

Tribal Affiliation(s)
Any Affiliation

Closing Date 2022-08-22