Medicaid Prior Authorization Specialist I
The vision: Through Native Self-Determination and Culturally Relevant Health Systems, we strive to be the healthiest people.
At the Yukon-Kuskokwim Health Corporation (YKHC) we administer a comprehensive healthcare system throughout 58 rural communities with a mission of Working Together to Achieve Excellent Health.
YKHC serves 58 federally-recognized Tribes and operates 41 Village Clinics. Our five larger communities are served by five Sub-Regional Clinics. All communities in our service area are served by the 55 bed regional hospital in Bethel.
For more information about our hospital or the region please visit
Yukon-Kuskokwim Health Corporation - We Strive to be the Healthiest People (www.ykhc.org)
Medicaid Prior Authorization Specialist I under normal supervision, 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 by documenting these findings in detail through the 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. Senior lead employees perform high level, complex and responsible tasks within this position and generally work with minimum supervision and follow-up from their supervisor.
The following duties are intended to provide a representative summary of the major duties and responsibilities and ARE NOT intended to serve as a comprehensive list of all duties listed and may be required to perform additional, position-specific duties.
For Medicaid eligible patients and/or escorts, works with clinical providers to determine if medical necessity has been met prior to transportation services. Also, 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.
This position will draw upon experience and general knowledge; will review documentation or contacts the provider or requestor when necessary in order to prove medical necessity for the authorization.
This position will also 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.
This position will 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. Performs other duties as assigned. KNOWLEDGE and 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.
- Skill in 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.
- 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.
- Generous PTO - beginning at 4.5 weeks
- Ten paid holidays
- Comprehensive healthcare coverage
- Life and Disability Insurance
- Flexible Spending Account
- Retirement plans
- Employee Wellness Center
ID:13815Location:BethelDepartment:Medicare/Medicaid EnrollmentEmployment Duration:80 Full timeTemporary Status:Not ApplicableHours per Week:40
Yukon Kuskokwim Health Corporation is an Affirmative Action/Equal Opportunity Employer. All qualified individuals will receive consideration for employment without regard to race, ethnicity, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status and any other basis protected by law. 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.
For more information, please contact the YKHC Recruitment Department at YKHCRecruitment@YKHC.org or phone (907) 543-6060 and ask to speak with a recruiter.
To view more positions available please visit YKHC Career Center (https://chu.tbe.taleo.net/chu01/ats/careers/v2/jobSearch?org=YKHC&cws=41)