Medicaid Enrollment Specialist l

Position Summary

The Medicaid Prior Authorization Specialist I assists in providing transportation/logistical assistance to Alaska Medicaid recipients, determining medical necessity, and handling prior authorization requests. This position requires close collaboration with clinical providers, the State of Alaska, and other stakeholders.

Representative Duties

• Work with clinical providers to determine medical necessity for transportation services
• Serve as liaison between YKHC and the State of Alaska regarding Medicaid Transportation Services
• Gather and communicate all necessary information to the Alaska State Medicaid Representative
• Review and document eligibility issues for Alaska Medicaid recipients
• Ensure appropriate documentation for medical necessity of travel authorization
• Coordinate with Prior Authorization, Provider Inquiry, and Claims Resolution units
• Answer provider inquiries in writing and verbally
• Submit claims, adjustments, voids, etc., electronically and in paper formats
• Evaluate and resolve claims
• Maintain a database of problems and actions taken
• Analyze findings and advise supervisor of significant system or provider problems/concerns
• Coordinate lodging and travel needs for patients
• May work outside traditional hours

Knowledge and Skills

• Customer service concepts and practices
• Privacy Act of 1974 and HIPAA Privacy Rule Act
• State, federal, and public/private insurance, including Medicaid/Medicare
• Data entry accuracy and detailed note-taking
• Grammar, spelling, sentence structure, and effective business letter writing
• Establishing and maintaining cooperative working relationships
• Operating a personal computer using various software applications

Qualifications

• High school diploma or equivalent
• Two (2) years of clerical AND customer service experience
• Basic computer/excel skills
• 10 touch experience preferred
• Must pass the State of Alaska HIPAA test
• Copiers, print, fax machines, and multi-line telephones
• Ability to work independently in a fast-paced office environment
• Ability to multi-task between different computer programs, retaining different passwords as needed

Benefits

• Generous PTO – beginning at 4.5 weeks
• Eleven paid holidays
• Comprehensive healthcare coverage
• Life and Disability Insurance
• Flexible Spending Account
• Retail plans
• Employee Wellness Center

Additional Information

• ID: 18692
• Location: Bethel
• Department: Medicare/Medicaid Enrollment
• Employment Duration: 80 Full time Temporary Status: Not Applicable
• Hrs per Week: 40
• Minimum Hourly Pay: $21.78
• FLSA Status: Non-exempt
• Yukon Kuskokwim Health Corporation is an Affirmative Action/Equal Opportunity Employer
• Individuals with disabilities needing assistance in the recruitment process are encouraged to contact Human Resources directly
• Under P.L. 93-638, preference is given to Alaska Native/American Indian applicants
• To view more positions available, please visit YKHC Career Center (https://chu.tbe.taleo.net/chu01/ats/careers/v2/jobSearch?org=YKHC&cws=41)