Medicaid Prior Authorization Specialist I

1 month ago

Bethel, United States Yukon-Kuskokwim Health Corp. Full time

Position Summary:

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.

REPRESENTATIVE 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 verballySubmit claims, adjustments, voids, etc., electronically and in paper formatsPerform 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 notesSkill 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.Position Qualifications:

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.Benefits Include :

Generous PTO - beginning at 4.5 weeksEleven paid holidaysComprehensive healthcare coverageLife and Disability InsuranceFlexible Spending AccountRetirement plansEmployee Wellness Center

CX #J-18808-Ljbffr

  • Medicaid Specialist

    2 weeks ago

    Bethel, United States Bethel Health & Rehabilitation Center Full time

    : **A Great Place to Work** Bethel is a proud affiliate of National Health Care Associates. As a Certified Great Place to Work, we think that you are going to love it here. Your work will be meaningful to you. You will make a genuine difference in the lives of our aging guests and the families that love them. You will enjoy lasting bonds with the families...

  • Medicaid Enrollment Specialist l

    2 weeks ago

    Bethel, United States Yukon-Kuskokwim Health Corp. Full time

    Description: Position Summary: The Medicaid Enrollment Specialist is required to screen and assist all patients, insured or uninsured in applying for the appropriate government programs, either Medicaid, Denali Kidcare or Medicare. Must be able to explain the significance of enrollment in programs to individuals, communities, and organizations. Assists...

  • Welder I

    2 months ago

    Bethel, United States Axelon Full time

    Welder I Pay rate: Min $22.00/hr, Max $22.00/hr Hours of Operation: 7:00AM - 3:30PM (1 Shift) Job Description: *Operate semi-automated welding machines *Perform TIG & EB welding operations on small aerospace parts (our final products fit in the palm of your hand) *Assemble, setup & maintain tooling *Perform leak testing operations *Operate heat treat and...

  • Welder I

    2 weeks ago

    Bethel, United States Belcan Full time

    Welder I Job Number: 349351 Category: Other Description: #NowHiring #Welder Job Title: Welder I Contract: 12 Months, Belcan is a leading provider of professional IT, Engineering, Workforce Solutions and staffing in the United States, Canada, UK, Europe and India. A Welder I Job in Bethel, CT is currently available through Belcan. In this role you will...

  • Welder I

    1 week ago

    Bethel, United States Belcan Full time

    Welder I Job Number: 349351 Category: Other Description: #NowHiring #Welder Job Title: Welder I Contract: 12 Months, Belcan is a leading provider of professional IT, Engineering, Workforce Solutions and staffing in the United States, Canada, UK, Europe and India. A Welder I Job in Bethel, CT is currently available through Belcan. In this role you will...

  • Clinical Support Specialist

    1 week ago

    Bethel, United States HealthReach Community Health Centers Full time

    Bethel Family Health Center is seeking a **Clinical Support Specialist** to join our active and friendly family practice. The Clinical Support Specialist supports the provider and nursing teams with administrative duties such as chart preparation, running reports, completing paperwork, and stocking rooms. This position provides back up for staff who answer...

  • Clinical Support Specialist

    7 days ago

    Bethel, United States HealthReach Community Health Centers Full time

    Bethel Family Health Center is seeking a **Clinical Support Specialist** to join our active and friendly family practice. The Clinical Support Specialist supports the provider and nursing teams with administrative duties such as chart preparation, running reports, completing paperwork, and stocking rooms. This position provides back up for staff who answer...

  • Clinical Support Specialist

    1 month ago

    Bethel, United States HealthReach Community Health Centers Full time

    Bethel Family Health Center is seeking a **Clinical Support Specialist** to join our active and friendly family practice. The Clinical Support Specialist supports the provider and nursing teams with administrative duties such as chart preparation, running reports, completing paperwork, and stocking rooms. This position provides back up for staff who answer...

  • Clinical Support Specialist

    1 week ago

    Bethel, United States HealthReach Community Health Centers Full time

    Bethel Family Health Center is seeking a **Clinical Support Specialist** to join our active and friendly family practice. The Clinical Support Specialist supports the provider and nursing teams with administrative duties such as chart preparation, running reports, completing paperwork, and stocking rooms. This position provides back up for staff who answer...

  • Third Party Recovery Specialist I

    2 months ago

    Bethel, United States Yukon-Kuskokwim Health Corporation Full time

    Position Summary: Responsible for accurate and timely submission and recovery of healthcare claims.  As the entry level Recovery Specialist, this individual will assist senior specialists with workload and work assigned tasks from Lead. Responsible for all routine actions required in resolving account balances. Incumbent must have the ability to adjust to...

  • Third Party Recovery Specialist I

    1 month ago

    Bethel, United States Yukon-Kuskokwim Health Corporation Full time

    Position Summary: Responsible for accurate and timely submission and recovery of healthcare claims.  As the entry level Recovery Specialist, this individual will assist senior specialists with workload and work assigned tasks from Lead. Responsible for all routine actions required in resolving account balances. Incumbent must have the ability to adjust to...

  • Third Party Recovery Specialist I

    1 week ago

    Bethel, United States Yukon-Kuskokwim Health Corporation Full time

    Position Summary: Responsible for accurate and timely submission and recovery of healthcare claims.  As the entry level Recovery Specialist, this individual will assist senior specialists with workload and work assigned tasks from Lead. Responsible for all routine actions required in resolving account balances. Incumbent must have the ability to adjust to...

  • Admissions Specialist l

    3 weeks ago

    Bethel, United States Yukon-Kuskokwim Health Corporation Full time

    Description: Position Summary: Perform registration, admission and scheduling functions for all inpatient and outpatient services provided by YKHC. Collect, update, and input patient demographics, history and insurance information into appropriate computer system. Maintain or establish patient eligibility and primary provider on all patient encounters....

  • Admissions Specialist l

    2 days ago

    Bethel, United States Yukon-Kuskokwim Health Corporation Full time

    Description: Position Summary: Perform registration, admission and scheduling functions for all inpatient and outpatient services provided by YKHC. Collect, update, and input patient demographics, history and insurance information into appropriate computer system. Maintain or establish patient eligibility and primary provider on all patient encounters....

  • Marketing - Manager I

    2 months ago

    Bethel, United States CareerBuilder Full time

    The Duracell North America Marketing team is looking for a passionate, fire-driven individual to join its Brand Communications team. Do you usually take the road less traveled? Do you get excited about unearthing rich consumer insights that lead to kick-ass creative? Are you driven by the relentless pursuit of catching lightning in a bottle? Then this job is...

  • Plant Health Care Specialist Trainee

    3 weeks ago

    Bethel, United States Bartlett Tree Experts Full time

     If you enjoy working outdoors in a professional and safe environment, consider a career with Bartlett Tree Experts! At Bartlett, we value a strong culture of excellence in safety, scientific research, lifelong learning, and career development.  We are seeking entry-level Plant Health Care Specialists who are ambitious self-starters, that have a passion...

  • Arborist Plant Health Care Specialist

    3 weeks ago

    Bethel, United States Bartlett Tree Experts Full time

     If you enjoy working outdoors in a professional and safe environment, consider a career with Bartlett Tree Experts! At Bartlett, we value a strong culture of excellence in safety, scientific research, lifelong learning, and career development.  We are seeking experienced Plant Health Care Specialists who are ambitious self-starters that have a passion for...

  • Plant Health Care Specialist Trainee

    1 week ago

    Bethel, United States Bartlett Tree Experts Full time

     If you enjoy working outdoors in a professional and safe environment, consider a career with Bartlett Tree Experts! At Bartlett, we value a strong culture of excellence in safety, scientific research, lifelong learning, and career development.  We are seeking entry-level Plant Health Care Specialists who are ambitious self-starters, that have a passion...

  • Arborist Plant Health Care Specialist

    1 week ago

    Bethel, United States Bartlett Tree Experts Full time

     If you enjoy working outdoors in a professional and safe environment, consider a career with Bartlett Tree Experts! At Bartlett, we value a strong culture of excellence in safety, scientific research, lifelong learning, and career development.  We are seeking experienced Plant Health Care Specialists who are ambitious self-starters that have a passion for...

  • Preschool Assistant Teacher

    2 months ago

    Bethel, United States The Regional YMCA Of Western Connecticut Full time

    Job DescriptionJob Description Teacher Assistants wanted for NAEYC accredited Centerin Bethel, CT (located near Danbury).  Seeking responsible,nurturing individuals with prior preschool experience . Monday – Friday 10:00-6:30 . Please email resume to mburbage@regionalymca.org.  EOE Job Posted by ApplicantPro