Job Details

Prior Authorization Technician

The Prior Authorization Technician supports the Health Systems Departments by completing prior authorizations as needed for services being rendered at Dena'ina Wellness Center. The Prior Authorization Technician reviews un'ina (patient) insurance information and determines if prior authorization is necessary prior to the provider providing direct un'ina (patient) care services. The Prior Authorization Technician communicates with the un'ina (patient), provider staff, and insurance company, to complete necessary prior authorization paperwork necessary for billing compliance.

Essential Functions:

• Examines un'ina (patient) records to determine if treatments or procedures require prior authorization, ensuring that each case is assessed accurately.
• Confirms un'ina (patient) insurance details, verifying that the coverage is in place for the proposed healthcare services.
• Responsible for preparing and submitting detailed prior authorization requests to insurance companies, complete with all necessary documentation.
• Works closely with healthcare providers to collect necessary clinical information, streamlining the authorization process.
• Tracks all prior authorization requests, follow up with insurance companies, and keep detailed records of all communications.
• Investigate insurance denials, resubmit requests, and appeal when needed to ensure that un'ina (patient) receive the care they require.
• Communicates with un'ina (patient) on the prior authorization process.
• Ensures compliance with Tribal, federal, state, and local employment laws and regulations, Tribal policies and TERO ordinance.

It is the intent of this job description to highlight the essential functions of the position; however, it is not an all-inclusive list. The incumbent may be called upon and required to follow or perform other duties and tasks requested by his/her supervisor, consistent with the purpose of the position, department and/or the Kenaitze Indian Tribe's objectives.

Working Conditions:

• Lifting Requirements - Light work - Exerting up to 20 pounds of force frequently, and/or a negligible amount of force constantly to move objects.
• Physical Requirements - Stand or Sit (Stationary position) - Walk (Move, Traverse) - Use hands/fingers to handle or feel (Operate, Activate, Use, Prepare, Inspect, Place, Detect, Position) - Talk/hear (Communicate, Detect, Converse with, Discern, Convey, Express oneself, Exchange information) - See (Detect, Determine, Perceive, Identify, Recognize, Judge, Observe, Inspect, Estimate, Assess) - Repetitive Motion
• OSHA Categories - Category III - Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid

Equipment and Tools:

• Computer, phone, scanner, copier, electronic health records

Travel - Local - In-State

Qualifications: