Prior Authorization Technician

Prior Authorization Technician

Department: Revenue Cycle

Program: Health Systems

Reports To: Revenue Integrity Supervisor

Employment Status: Full-Time

FLSA Status: Non-Exempt

Schedule: 40 Hours/52 Weeks

Preference: TERO Ordinance 2017-01, P.L. 93-638

Job Summary

The 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 Functions

• Examines un'ina (patient) records to determine if treatments or procedures require prior authorization, ensuring that each case is assessed accurately
• Confirms un'ina (patient) insurance details, verifying that the coverage is in place for the proposed healthcare services
• Responsible for preparing and submitting detailed prior authorization requests to insurance companies, complete with all necessary documentation
• Works closely with healthcare providers to collect necessary clinical information, streamlining the authorization process
• Tracks all prior authorization requests, follow up with insurance companies, and keep detailed records of all communications
• Investigates insurance denials, resubmit requests, and appeal when needed to ensure that un'ina (patient) receive the care they require
• Communicates with un'ina (patient) on the prior authorization process
• Ensures compliance with Tribal, federal, state, and local employment laws and regulations, Tribal policies and TERO ordinance

It 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 Conditions

Lifting Requirements

• Light 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 Requirements

• Stand 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 Motion

OSHA Categories

• Category 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 aid

Equipment and Tools

Equipment used for job: Computer, phone, scanner, copier, electronic health records

Travel

• Local
• In-State

Qualifications

Education

• High School Diploma or GED

Experience

• Two (2) years of medical insurance and/or medical billing
• Proficiency in electronic health records

Preferred

• Knowledge and experience working with cultural diversities
• Associates degree in related field
• Experience with Indian Health Services facilities operations

Special Skills

• Proficiency with Microsoft Suite, or obtain training within 90 days of hire
• Conducts business in a service-oriented manner that is attentive, pleasant, respectful and kind when dealing with un'ina, visitors, co-workers and others
• Ability to multi-task, work independently, and meet deadlines
• Knowledge of prior authorization process
• Knowledge 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 terminology
• Customer service experience
• Excellent written and oral communication skills

This 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.