Prior Authorization Technician

Job Description

Job Description

Prior Authorization TechnicianDepartment: Revenue CycleProgram: Health SystemsReports To: Revenue Integrity SupervisorEmployment Status: Full-TimeFLSA Status: Non-Exempt Schedule: 40 Hours/52 WeeksPreference: TERO Ordinance 2017-01, P.L. 93-638Job SummaryThe Prior Authorization Technician supports the Health Systems Departments by completing prior authorizations as needed for services being rendered at Dena'ina Wellness Center. The Prior Authorization Technician reviews un'ina (patient) insurance information and determine if prior authorization is necessary prior to the provider providing direct un'ina (patient) care services. The Prior Authorization Technician communicates with the un'ina (patient), provider staff, and insurance company, to complete necessary prior authorization paperwork necessary for billing compliance.Essential FunctionsExamines un'ina (patient) records to determine if treatments or procedures require prior authorization, ensuring that each case is assessed accuratelyConfirms un'ina (patient) insurance details, verifying that the coverage is in place for the proposed healthcare servicesResponsible for preparing and submitting detailed prior authorization requests to insurance companies, complete with all necessary documentationWorks closely with healthcare providers to collect necessary clinical information, streamlining the authorization processTracks all prior authorization requests, follow up with insurance companies, and keep detailed records of all communicationsInvestigates insurance denials, resubmit requests, and appeal when needed to ensure that un'ina (patient) receive the care they requireCommunicates with un'ina (patient) on the prior authorization processEnsures compliance with Tribal, federal, state, and local employment laws and regulations, Tribal policies and TERO ordinanceIt is the intent of this job description to highlight the essential functions of the position; however, it is not an all-inclusive list. The incumbent may be called upon and required to follow or perform other duties and tasks requested by his/her supervisor, consistent with the purpose of the position, department and/or the Kenaitze Indian Tribe's objectives.Working ConditionsLifting RequirementsLight work - Exerting up to 20 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg control requires exertion of forces greater than that of sedentary work and if the worker sits most of the time, the job is considered light work.Physical RequirementsStand or Sit (Stationary position)Walk (Move, Traverse)Use hands/fingers to handle or feel (Operate, Activate, Use, Prepare, Inspect, Place, Detect, Position)Talk/hear (Communicate, Detect, Converse with, Discern, Convey, Express oneself, Exchange information)See (Detect, Determine, Perceive, Identify, Recognize, Judge, Observe, Inspect, Estimate, Assess)Repetitive MotionOSHA CategoriesCategory III - Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aidEquipment and ToolsEquipment used for job: Computer, phone, scanner, copier, electronic health recordsTravelLocalIn - StateQualificationsEducationHigh School Diploma or GEDExperienceTwo (2) years of medical insurance and/or medical billingProficiency in electronic health recordsPreferredKnowledge and experience working with cultural diversitiesAssociates degree in related fieldExperience with Indian Health Services facilities operationsSpecial SkillsProficiency with Microsoft Suite, or obtain training within 90 days of hireConducts business in a service-oriented manner that is attentive, pleasant, respectful and kind when dealing with un'ina, visitors, co-workers and othersAbility to multi-task, work independently, and meet deadlinesKnowledge of prior authorization processKnowledge of billing and coding for Primary Care, Dental, Optometry, Laboratory, Therapy Services, Radiology, Pharmacy, Behavioral Health, etc.General knowledge of CPT and ICD-10 codes and medical terminologyCustomer service experienceExcellent written and oral communication skillsThis position is a Covered Position subject to all requirements of the Alaska Barrier Crimes Act (ABCA) and to the Indian Child Protection and Family Violence Prevention Act, (ICPA). ABCA and ICPA requirements apply and must be complied with at all times in order to remain in the position.*Memorandum of Understanding: Serves as documented evidence that the Kenaitze Indian Tribe has expressed the ineligibility of an employee to operate motor vehicles owned, leased or rented by the Kenaitze Indian Tribe, or to operate a personal vehicle on behalf of the Kenaitze Indian Tribe.

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