PRC Authorization Specialist — Elevate Patient Access

Kodiak Area Native Association; Alaska; On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

401(k) with employer contribution

Paid Parental Leave

Employer-paid health coverage

Loan repayment programs eligibility

Tuition assistance

Wellness benefits and EAP

Job summary

Kodiak Area Native Association (KANA) is seeking a PRC Authorization Specialist to review, process, and document referrals and related claims to determine patient eligibility and funding for referred care services. This role ensures compliance with PRC policies, healthcare regulations, and payer requirements while maintaining accurate records in Cerner.

The specialist collaborates with internal teams and external partners to support patient access to care and appropriate use of healthcare

Qualifications

• High school diploma or GED with two years in an office setting.
• Familiarity with federal, state, and local resources for patient health and social services.
• Knowledge of medical billing, HIPAA, and healthcare regulations.

Responsibilities

• Review referrals to determine PRC eligibility and funding.
• Use Cerner to verify service needs, eligibility, and required docs.
• Process referrals in line with PRC policies and regulations.
• Follow Finance requirements for purchasing and payment processing.
• Identify alternate insurance coverage and ensure proper billing.
• Apply limits to requisitions (dates, visits, values).
• Prepare denial letters and attach to referrals in Cerner.
• Reassign completed referrals to the Referred Care Coordinator.
• Document all eligibility determinations in patient records.
• Communicate with Patient Benefit Coordinators about uninsured patients.

Skills

Medical billing knowledge

HIPAA compliance

Customer service

Office administration

Education

High school diploma or GED

Tools

Cerner software

Job description

Kodiak Area Native Association (KANA) is seeking a PRC Authorization Specialist to review, process, and document referrals and related claims to determine patient eligibility and funding for referred care services. This role ensures compliance with PRC policies, healthcare regulations, and payer requirements while maintaining accurate records in Cerner.

The specialist collaborates with internal teams and external partners to support patient access to care and appropriate use of healthcare