PRIOR AUTHORIZATION SPECIALIST I - FULLTIME - JOB ID: 2351

 

The Alaska Native Tribal Health Consortium is a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska. In partnership with the more than 171,000 Alaska Native and American Indian people that we serve and the Tribal health organizations of the Alaska Tribal Health System, ANTHC provides world-class health services, which include comprehensive medical services at the Alaska Native Medical Center, wellness programs, disease research and prevention, rural provider training and rural water and sanitation systems construction.

 

ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska's second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation's largest state.

 

Our vision: Alaska Native people are the healthiest people in the world.

Mission statement: Providing the highest quality health services in partnership with our people and the Alaska Tribal Health System.

 

Benefits include:

• Generous Paid Time Off and holiday schedule. 4 weeks paid vacation per year to start and 12 paid holidays.
• More than 19 Federal healthcare plans. Plans for employee, employee plus one, and employee plus family available. ANTHC covers 80% of all health insurance premiums and 100% of Short-Term Disability, Long-Term Disability, Dental, Vision, Basic Life, and AD&D.
• 401(a) retirement plan; ANTHC will contribute 3% of your annual compensation to the plan account each year, with up to an additional 5% match. 6-year vesting schedule.
• 403(b) retirement savings plan pre-tax and Roth options. Flexible Spending Accounts for Health Care and Dependent care are also available.
• Onsite Child Care in a brand new education facility.
• Onsite free gym access. Additional gym, rock climbing wall and salt-water pool available at the Alaska Pacific University for a small fee per semester. Steep discounts on outdoor equipment rentals available for your Alaskan adventures!
• Tuition reductions for employees and their eligible dependents at the Alaska Pacific University.

 

Visit us online at www.anthc.org or contact Recruitment 907-729-1301 or contact us here

 

Alaska Native Tribal Health Consortium has a hiring preference for qualified Alaska Native and American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.

Summary:

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.

 

Responsibilities:

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.

 

Other information:

 

KNOWLEDGE and 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.

MINIMUM EDUCATION QUALIFICATION

Prior Authorization Specialist I & II

A high school diploma or GED equivalent.

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.

PREFERRED EXPERIENCE QUALIFICATION

Basic computer, software applications and data entry experience

ADDITIONAL REQUIREMENTS

Shift may include one weekend shift and holidays.