DirectJobHub
Jobs · Alaska

Medicaid Enrollment Specialist l

Yukon-Kuskokwim Health Corporation · Bethel, AK · 2 mo ago
Full-time

About the role

The Yukon-Kuskokwim Health Corporation is a Tribal health care organization serving nearly 30,000 people across rural southwest Alaska. Bethel, the regional hub and location of the only hospital in the region, has a population of nearly 7,000. The Yukon-Kuskokwim Delta is home to thousands of lakes and two primary rivers—the Kuskokwim and Yukon.

The Medicaid Prior Authorization Specialist I, under normal supervision, assists in providing transportation/logistical assistance to Alaska Medicaid Recipients traveling to and from the YKHC service area by determining if the burden of medical necessity has been met and documenting these findings in detail through appropriate computer systems.

Level 1 employees perform work under close supervision, may only perform simple or routine aspects of the position, and generally require a good deal of instruction and/or training.

Responsibilities

  • For Medicaid eligible patients and/or escorts, work with clinical providers to determine if medical necessity has been met prior to transportation services
  • Serve as the liaison between YKHC and the State of Alaska regarding Medicaid Transportation Services
  • Gather all information requested by Alaska State Medicaid Representative utilizing various computer systems and communicating with all parties involved so that prior authorization requests can be handled in a timely manner
  • Work collaboratively with patients on eligibility issues
  • Know when to refer patients to YKHC Medicaid Enrollment department and/or Alaska Division of Public Assistance (DPA) to move authorization along expeditiously
  • Review documentation or contact the provider or requestor when necessary to prove medical necessity for the authorization
  • Ensure appropriate documentation exists to prove the medical necessity of travel authorization
  • Ensure all submitted authorizations reflect the correct CPT and diagnosis codes and authorization numbers correspond to the dates and services authorized
  • Coordinate with or assume functions of Prior Authorization, Provider Inquiry and Claims Resolution units to ensure provider/claims resolution
  • Answer provider inquiries in writing and verbally
  • Submit claims, adjustments, voids, etc., electronically and in paper formats
  • Perform and/or evaluate Prior Authorization on-line updates ensuring notes are accurate and demonstrate medical necessity for authorization approval and/or denial
  • Perform and/or evaluate and/or resolve process claims
  • Maintain a database of information reflecting problems found and actions taken
  • Analyze findings and advise supervisor of significant system or provider problems/concerns
  • Work closely with State entities involved with provider claims
  • Work closely with YKHC office assistants/health aides and providers, ANTHC/YKHC Medicaid Travel Offices, and the State of Alaska to coordinate customer lodging and travel needs
  • May be required to work outside the traditional work schedule
  • Perform other duties as assigned

Qualifications

  • High school diploma or equivalent
  • Computer literacy required
  • Non-supervisory – Two (2) years of clerical AND customer service experience (an equivalent combination of relevant education and/or training may be substituted for experience)
  • Basic computer/Excel skills
  • 10 touch experience preferred
  • Must take the State of Alaska HIPAA test

Skills

  • Knowledge of customer service concepts and practice
  • Knowledge of the Privacy Act of 1974 and HIPAA Privacy Rule Act of 1966
  • Knowledge of state, federal and public/private insurance, including Medicaid/Medicare
  • Accuracy with data entry and ability to make detailed notes
  • Grammar, spelling, sentence structure and effective business letter writing
  • Establishing and maintaining cooperative working relationships with others
  • Operating a personal computer utilizing a variety of software applications and ability to retain multiple passwords
  • Ability to access multiple computer programs simultaneously
  • Ability to work in a fast-paced office independently
  • Ability to multi-task between different computer programs, retaining different passwords as needed
  • Copiers, print, fax machines, and multi-line telephones

Benefits

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

Pay

Minimum hourly pay: $21.78

Schedule

40 hours per week, full-time

Similar jobs