Prior Authorization Specialist I

About the role

The Alaska Native Tribal Health Consortium (ANTHC) is seeking a candidate to assist in screening patient eligibility and assessing clinical information for Medicaid Travel Benefits. This position involves evaluating patient documentation, coordinating with healthcare providers, and ensuring compliance with state and federal regulations.

Responsibilities

• Conduct clinical evaluations of patient documentation to determine eligibility for Medicaid Travel Benefits under Alaska State Medicaid Program rules and regulations.
• Serve as a liaison between patients, ANMC, and the State of Alaska to prove medical necessity for Medicaid Travel Authorizations.
• Communicate with patients and healthcare professionals to update them on authorization information and document requirements.
• Gather and provide all necessary information requested by the Alaska State Medicaid Representative using various computer systems and communication with ANMC or Tribal Health Partner RN Case Managers.
• Inform patients about other available services and resources.
• Work collaboratively with other team members and external agencies to ensure compliance with state and federal regulations.
• Determine continued or amended eligibility in real-time with tribal travel agencies and make necessary accommodations.
• Affirm that all submitted authorizations contain correct CPT and diagnosis codes and correspond to the services authorized.
• Coordinate with Prior Authorization, Provider Inquiry, and Claims Resolution units to ensure provider/claims resolution.
• Analyze findings and report significant issues or concerns to the supervisor, including production reports and interactions with state entities.

Requirements

• Knowledge of Alaska Tribal Health System, ANTHC, and Alaska Native culture(s).
• Knowledge of alternative health resources.
• Knowledge of customer service concepts and practices.
• 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.
• Accuracy with data entry and detailed note-taking skills.
• Ability to work independently or as part of a team.
• Effective communication skills, both oral and written.
• Proficiency in operating office equipment and personal computers with various applications.

Skills

• Excellent communication skills, both verbal and written.
• Ability to manage multiple tasks and meet deadlines.
• Strong interpersonal skills to handle distressed customers.
• Basic computer and software applications proficiency.
• Ability to establish and maintain cooperative working relationships.

Benefits

ANTHC offers a competitive and comprehensive Benefits Package, including:

• Medical Insurance through the Federal Employee Health Benefits Program with over 20 plans and tiers.
• Cost-Share Dental and Vision Insurance.
• Discounted Pet Insurance.
• Retirement Contributions with Pre-Tax or Roth options into a 403(b).
• 401(a) ANTHC Retirement Plan with up to 5% matching contributions based on employee contributions.
• Paid Time Off starting immediately, with 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 covered 100% by ANTHC.
• 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 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.
• Licenses and certifications reimbursed and occupational insurance for medical staff.
• Gym Access to Alaska Pacific University with discounts for outdoor equipment rentals.
• Emergency Travel Assistance.
• Education Assistance or Education leave eligibility.
• Discount program for travel, gym memberships, amusement parks, and more.

Other Information

This position requires weekend shifts and holidays. ANTHC is committed to hiring qualified Alaska Native and American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.