Kenaitze Indian Tribe
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.
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.