Purchased and Referred Care Authorization Specialist

Kodiak Area Native Association (KANA) is a Tribal health organization committed to elevating the lives of the people we serve. At KANA, employees are more than staff members; they are part of a mission-driven team focused on meaningful work, community impact, and long-term growth. Benefits & Perks 401(k) retirement plan with a 7% employer contribution beginning in year two, paid regardless of employee contribution Paid Parental Leave 80% employer-paid medical, dental, and vision coverage Access to 20+ medical plan options through federal OPM benefits Employer-paid life insurance at 2.5x annual salary AD&D, short-term, and long-term disability coverage Generous paid time off and 13 paid holidays Free gym membership to the KANA Wellness Center Employee Assistance Program (EAP) Tuition assistance and reimbursement programs Leadership development and internal advancement opportunities Eligibility for IHS and NHSC loan repayment programs (role dependent) Potential temporary housing assistance for relocating employees, based on availability Position Overview The Purchased and Referred Care (PRC) Authorization Specialist reviews, processes, and documents 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 resources. Key Responsibilities Review referrals to determine PRC eligibility, funding criteria, and medical necessity for referred services Utilize Cerner to verify service needs, referral locations, patient eligibility, and required documentation; conduct research as needed to confirm eligibility Process referrals in accordance with PRC policies, healthcare regulations, and organizational procedures Follow Finance requirements for purchasing and payment processing to ensure accurate and timely transactions Identify and document alternate insurance coverage and ensure appropriate billing prior to KANA, consistent with payer-of-last-resort guidelines Apply limits to requisitions, including dates of service, number of visits, and visit values Prepare denial documentation when applicable and upload approval or denial letters into Cerner, ensuring proper attachment to referrals Reassign completed referrals with full documentation to the Referred Care Coordinator for next steps Accurately document all eligibility determinations and decisions within patient records in Cerner Communicate with Patient Benefit Coordinators regarding uninsured patients and eligibility options Support organizational mission, patient-centered care principles, and quality standards in all daily activities Demonstrate KANA's core values of Courtesy, Caring, Respect, Sharing, and Pride in all work interactions Uphold KANA's Code of Ethics by maintaining professionalism, integrity, and confidentiality in all responsibilities Participate in ongoing training related to PRC, medical billing, coding, and healthcare compliance Occasional travel may be required Qualifications High school diploma or general education degree (GED) and two years of experience working with the public in an office setting; or an equivalent combination of education and experience Familiarity with federal, state, and local resources available to meet patient health and social service needs preferred Knowledge of medical billing procedures, medical terminology, HIPAA, and applicable healthcare regulations required Work Schedule KANA's standard work schedule is 37.5 working hours per week, consisting of 7.5 paid working hours per day plus a one-hour unpaid lunch break (8.5 hours on site per day). This position may require occasional schedule flexibility based on operational needs. Our Values KANA's work is guided by Courtesy, Caring, Respect, Sharing, and Pride. We seek team members who embody these values in how they serve patients, collaborate with colleagues, and support the community. Life In Kodiak Located on beautiful Kodiak Island, this role offers the opportunity to build meaningful community connections while experiencing Alaska's unique coastal lifestyle, outdoor recreation, and close-knit community. #J-18808-Ljbffr