Medicaid Prior Authorization Specialist I

About the role

The Yukon-Kuskokwim Health Corporation is a Tribal health care organization serving nearly 30,000 people in rural, southwest Alaska. Bethel, the regional hub and location of the only hospital in the region, has a population of nearly 7,000. This position is part of the Medicaid Prior Authorization team.

Responsibilities

• Assists in providing transportation/logistical assistance to Alaska Medicaid Recipients traveling to and from the Yukon Kuskokwim Health Corporation (YKHC) service area by determining if the burden of medical necessity has been met.
• Serves as the liaison between the YKHC and the State of Alaska regarding Medicaid Transportation Services.
• Gathers all information requested by the Alaska State Medicaid Representative by utilizing various computer systems and by communicating to all parties involved so that all prior authorization requests can be handled in a timely manner.
• Work collaboratively with patient on eligibility issues. Must be knowledgeable about when to refer patient to the YKHC Medicaid Enrollment department and/or Alaska Division of Public Assistance (DPA) to move authorization along in an expeditious manner.
• Ensure that there is appropriate 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 will assume the function of Prior Authorization, Provider Inquiry and Claims Resolution units to ensure provider/claims resolution.
• Answer provider inquires in writing and verbally Submit claims, adjustments, voids, etc., electronically and in paper formats.
• Perform and/or evaluate Prior Authorization on-line updates ensuring that notes are accurate and demonstrate the medical necessity for the 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 Office’s and the State of Alaska to coordinate the customers lodging and travel needs.
• May be required to work outside the traditional work schedule.

Requirements

• 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.
• Copiers, print, fax machines, and multi-line telephones.
• Be able to access multiple computer programs simultaneously.
• Be able to work in a fast paced office independently.
• Be able to multi-task between different computer programs, retaining different passwords as needed.

Qualifications

• High school diploma or equivalent.
• Two (2) years of clerical AND customer service 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 the ability to make detailed notes.
• Skill in grammar, spelling, sentence structure and effective business letter writing.
• Skill in establishing and maintaining cooperative working relationships with others.
• Skill in operating a personal computer utilizing a variety of software applications and be able to retain multiple passwords.

Benefits

• Generous PTO – starting at 4.5 weeks per year, accrued over time
• Eleven paid holidays
• Comprehensive healthcare coverage
• Life and Disability Insurance
• Flexible Spending Account
• Retail plans
• Employee Wellness Center
• Plus More!