Prior Authorization Specialist I

Alaska Native Tribal Health Consortium (ANTHC); Anchorage (AK); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Medical Insurance

Dental & Vision Insurance

Paid Time Off

11 Paid Holidays

Parental Leave

Retirement 401(a) with employer match

Tuition Discounts

On-Site Child Care

Job summary

ANTHC in Alaska seeks a Staff Member to screen patient eligibility for Medicaid Travel Benefits and assist clinics in navigating the program. The role emphasizes accurate documentation review and helping patients access travel assistance through ANMC and state partners.

Responsibilities include coordinating with Medicaid officials, ensuring proper CPT/diagnosis coding, and advocating for patients while maintaining compliance. Weekend/holiday shifts may be required as part of coverage.

Qualifications

• High school diploma or GED is required.
• Minimum: 1 year Alaska Medicaid experience AND 2 years of customer centric experience.
• Basic computer, data entry, and documentation skills.

Responsibilities

• Evaluate documentation to determine Medicaid Travel Benefits eligibility.
• Serve as liaison between patient, ANMC and the State of Alaska regarding Medicaid Transportation Services and medical necessity for travel authorization.
• Communicate effectively with patients and healthcare professionals about required documents and authorization status.
• Coordinate with Prior Authorization, Provider Inquiry, and Claims Resolution units to ensure provider/claims resolution.
• Ensure accurate CPT and diagnosis codes and that authorizations reflect dates and services.

Skills

Alaska Tribal Health System knowledge

Customer service

Medical terminology

HIPAA privacy

Insurance/program knowledge

Data entry accuracy

Multitasking

Oral and written communication

Education

High school diploma or GED

Job description

The Alaska Native Tribal Health Consortium is a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska. In partnership with the more than 171,000 Alaska Native and American Indian people that we serve and the Tribal health organizations of the Alaska Tribal Health System, ANTHC provides world-class health services, which include comprehensive medical services at the Alaska Native Medical Center, wellness programs, disease research and prevention, rural provider training and rural water and sanitation systems construction.

ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska's second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation’s largest state.

Our vision: Alaska Native people are the healthiest people in the world.

ANTHC offers a competitive and comprehensive Benefits Package for all Benefit Eligible Employees, which includes:

• Medical Insurance provided through the Federal Employee Health Benefits Program as a Tribal Employee, with over 20 plans and tiers.
• Cost-share Dental and Vision Insurances
• Discounted Pet Insurance
• Retirement Contributions with Pre-Tax or Roth options into a 403(b).
• 401(a) ANTHC Retirement Plan: After one year of employment, ANTHC will begin making matching contributions of up to 5% of your eligible pay, based on your own contributions. In addition, you may be eligible for an annual discretionary contribution of up to 3% from the employer.
• Paid Time Off starts immediately, earning up to 6 hours per pay period, with paid time off 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 are covered 100% by ANTHC, with additional options for Short-Term Disability Buy-Up Coverage and Voluntary Life for yourself and your family members.
• 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 with support 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.
• License and certification reimbursements and occupational insurance for medical staff.
• Emergency Travel Assistance
• Education Assistance or Education leave eligibility
• Discount program for travel, gym memberships, amusement parks, and more.

Alaska Native Tribal Health Consortium has a hiring preference for qualified Alaska Native and American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.

Position Summary

Under supervision, screen patient eligibility and assess clinical information, referred patients to determine eligibility for State of Alaska Medicaid Travel Benefits. Assist the patient, clinic and service unit with successful evaluation and submission for patient travel benefits.

Position Responsibilities

Conducts clinical evaluations of documentation provided by the patient, ANMC, and healthcare entities to determine eligibility for patient travel benefits under the rules and regulations of the Alaska State Medicaid Program. Serves as the liaison between the patient, ANMC and the State of Alaska regarding Medicaid Transportation Services to prove medical necessity for a Medicaid Travel Authorization.

Must be able to communicate effectively with patients and various healthcare professional providing updates on authorization information and required documents needed to be sent to the State of Alaska. Gathers all information requested by the Alaska State Medicaid Representative by utilizing various computer systems and by communicating with ANMC or Tribal Health Partner RN Case Managers. Informs customers about other services and resources that are available to them.

Works collaboratively with other members of the team and departments, as well as outside agencies, to ensure the State of Alaska Rules and Regulations are being met while also serving as an advocate for the patient and referring provider. Will determine continued or amended eligibility in real time with all tribal travel agencies and relative accommodations.

Ensures that there is accurate 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.

Coordinates with or assumes the function of Prior Authorization, Provider Inquiry, and Claims Resolution units to ensure provider/claims resolution.

Analyzes findings and advise supervisor of significant system or provider problems/concerns, work aged or other associated production reports as well as all State entities involved with provider claims.

KNOWLEDGE And SKILLS

• Performs other duties as assigned or required.
• 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.
• Skill in accuracy with data entry and the ability to make detailed notes.
• Skill in working independently or as a team member.
• Skill in dealing with distressed customers.
• Skill in grammar, spelling, sentence structure and effective business letter writing.
• Skill in operating office equipment, including copiers and fax machines.
• Skill in interpreting state, federal, and public/private insurance financing.
• Skill in oral and written communication.
• Skill in managing multiple priorities and tasks concurrently and meeting deadlines.
• Skill in establishing and maintaining cooperative working relationships with others.
• Skill in operating a personal computer utilizing a variety of applications.

MINIMUM EDUCATION QUALIFICATION

High school diploma or GED equivalent.

Minimum Experience Qualification

Non-supervisory – One (1) year of Alaska Medicaid experience AND two (2) years of customer centric experience. An equivalent combination of relevant education and/or training may be substituted for experience.

Preferred Experience Qualification

Basic computer, software applications and data entry experience.

Additional Requirements

Will need to be able to work weekend shifts and holidays.