Prior Authorization Specialist II - Medicaid Prior Authorization

About the role

The Alaska Native Tribal Health Consortium (ANTHC) is seeking a Patient Eligibility Specialist to assist in evaluating and submitting patient travel benefits for Medicaid reimbursement. This position works closely with patients, ANMC, and healthcare entities to ensure proper documentation and eligibility for travel benefits.

Responsibilities

• Conduct clinical evaluations of patient documentation to determine eligibility for Medicaid Travel Benefits
• Serve as a liaison between patients, ANMC, and the State of Alaska regarding Medicaid Transportation Services
• Communicate with patients and healthcare professionals to update authorization information and gather required documents
• Gather all necessary information from various computer systems and communicate with ANMC or Tribal Health Partner RN Case Managers
• Inform customers about other available services and resources
• Work collaboratively with other team members and external agencies to ensure compliance with state and tribal travel agency rules and regulations
• Determine continued or amended eligibility in real-time with tribal travel agencies and provide necessary accommodations
• Avoidance of errors in documentation to prove medical necessity of travel authorization
• Analyze findings and report significant issues or concerns to supervisor
• Coordinate with Prior Authorization, Provider Inquiry, and Claims Resolution units to ensure provider/claims resolution

Qualifications

• 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
• Accuracy with data entry and detailed note-taking skills
• Ability to work independently or as part of a team
• Effective communication and problem-solving skills
• Basic computer, software applications, and data entry experience
• Will need to work weekend shifts and holidays

Skills

• Accuracy with data entry and detailed note-taking skills
• Ability to work independently or as part of a team
• Effective communication and problem-solving skills
• Basic computer, software applications, and data entry experience