Job Details

Prior Authorization Specialist I - Medicaid Prior Authorization

Join to apply for the Prior Authorization Specialist I - Medicaid Prior Authorization role at Alaska Native Tribal Health Consortium (ANTHC)

About ANTHC

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 Alaskas second?largest health employer with more than 3,100 employees offering an array of health services to people throughout Alaska. Our vision: Alaska Native people are the healthiest people in the world.

Benefits

• Medical Insurance provided through the Federal Employee Health Benefits Program as a Tribal Employee, with over 20 plans and tiers.
• Cost?Share Dental and Vision Insurances
• Discounted Pet Insurance
• Retirement Contributions with Pre?Tax or Roth options into a 403(b).
• 401(a) ANTHC Retirement Plan: After one year of employment, ANTHC will begin making matching contributions of up to 5% of your eligible pay, based on your own contributions. In addition, you may be eligible for an annual discretionary contribution of up to 3% from the employer.
• Paid Time Off starts immediately, earning up to 6 hours per pay period, with paid time off accruals increasing based on years of service.
• Eleven Paid Holidays
• Paid Parental Leave or miscarriage/stillbirth eligibility after six months of employment
• Basic Short/Long Term Disability premiums, Accidental Death and Dismemberment (AD&D) Insurance, and Basic Life Insurance are covered 100% by ANTHC, with additional options for Short?Term Disability Buy?Up Coverage and Voluntary Life for yourself and your family members.
• Flexible Spending Accounts for Healthcare and Dependent Care.
• Ancillary Cash Benefits for accident, hospital indemnity, and critical illness.
• On?Site Child Care Facility with expert?designed classrooms for early child development and preschool.
• Employee Assistance Program with support for grief, financial counseling, mental/emotional health, and discounted legal advice.
• Tuition Discounts for you and your eligible dependents at Alaska Pacific University.
• On?Site Training Courses and Professional Development Opportunities.
• License and certification reimbursements and occupational insurance for medical staff.
• Gym Access to Alaska Pacific University includes a salt water pool, rock climbing, workout gym, and steep discounts for outdoor equipment rentals.
• Emergency Travel Assistance
• Education Assistance or Education leave eligibility
• Discount program for travel, gym memberships, amusement parks, and more.

Job 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

• Conduct 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.
• Serve 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.
• Communicate effectively with patients and various healthcare professionals providing updates on authorization information and required documents needed to be sent to the State of Alaska.
• Gather 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.
• Inform customers about other services and resources that are available to them.
• Work collaboratively with other team members 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.
• Determine continued or amended eligibility in real time with all tribal travel agencies and relative accommodations.
• Ensure accurate documentation to prove the medical necessity of the travel authorization. All submitted authorizations should reflect the correct CPT and diagnosis codes.
• All authorization 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.
• Perform other duties as assigned or required.

Knowledge, Skills and Experience

• 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

A high school diploma or GED equivalent.

Minimum Experience Qualification

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

Will need to be able to work weekend shifts and holidays.

EEO Statement

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.