The Alaska Native Tribal Health Consortium is a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska. In partnership with the more than 171,000 Alaska Native and American Indian people that we serve and the Tribal health organizations of the Alaska Tribal Health System, ANTHC provides world-class health services, which include comprehensive medical services at the Alaska Native Medical Center, wellness programs, disease research and prevention, rural provider training and rural water and sanitation systems construction.

ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska’s second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation’s largest state.

Our vision: Alaska Native people are the healthiest people in the world.

Benefits include:

• Generous Paid Time Off and holiday schedule with 4 weeks paid vacation per year to start and 12 paid holidays.

• More than 19 Federal healthcare plans with plans for employee, employee plus one, and employee plus family available. ANTHC covers 80% of all health insurance premiums and 100% of Short-Term Disability, Long-Term Disability, Dental, Vision, Basic Life, and AD&D.

• 401(a) retirement plan; ANTHC will contribute 3% of your annual compensation to the plan account each year, with up to an additional 5% match with a 6-year vesting schedule.

• 403(b) retirement savings plan with pre-tax and Roth options. Flexible Spending Accounts for Health Care and Dependent care are also available.

• Onsite Child Care is available in a brand new education facility.

• Onsite free gym access. Additional gym, rock climbing wall and salt-water pool available at the Alaska Pacific University for a small fee per semester. Steep discounts on outdoor equipment rentals for your Alaskan adventures!

• Tuition reductions for employees and their eligible dependents at the Alaska Pacific University.

Alaska Native Tribal Health Consortium has a hiring preference for qualified Alaska Native and American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.

Summary:

Under general supervision, perform tasks on behalf of Alaska Native Tribal Health Consortium Specialty Clinic Departments and ANMC Purchased Referred Care (PRC) for the purposes of efficiently and accurately assisting in executing all aspects of the external referral and emergent authorization process. Promote the quality and cost effectiveness of referred medical care by processing pre-authorizations in collaboration with medical providers, nursing staff, and other patient care support staff.

Responsibilities:

PRC Referral Coordinator I-II

Monitor the Electronic Health Record (EHR) notifications and established referral systems throughout the day to capture, process, and document external medical referral requests according to standard operational procedures.

Preform daily and/or period review of pending external medical referrals to identify health services that will require pre-authorization. Work closely with the specialty clinic and PRC nurse case managers to provide authorization(s) according to approved policies and procedures of the ANMC PRC program.

Gather pertinent information, including patient demographic and clinical information such as eligibility, health screening, insurance status, medical priority, referring service and provider(s), and purpose of referral.

Accurately complete referrals for PRC authorization within established timeframes and provides status of the request to the referring service. Communicate with referring service, case manager, health benefits team, or central registration team for any identified issues and/or requirements.

Assists referring specialty clinics in providing an eligibility/referral card to patients referred out of ANMC for scheduled care. Sends Authorization Letters to external provider and/or facility to communicate the pre-authorization of services and coordination of benefits for the primary referral.

Enrolls new students into ANMC PRC Student Program according to established policies and procedures. Assists with submitting patient registration worksheets to Central Registration if needed. Requests and verifies supporting documents for enrollment including proof of full-time admission, eligibility, etc.

Performs other duties as assigned, related to ANTHC PRC program and initiatives.

Other information:

KNOWLEDGE and SKILLS

All

· Knowledge of applicable federal, state, and tribal healthcare programs.

· Knowledge of state, federal, and public/private insurance carrier regulations including Centers for Medicare and Medicaid.

· Knowledge of general medical terminology, anatomy, physiology and concepts of diseases.

· Knowledge of ICD-10 and CPT coding.

· Knowledge of the Privacy Act of 1974 and HIPAA Privacy Rule Act of 1966.

· Skill in customer service with strong communication skills using the telephone and electronic media

· Skill in operation of a personal computer utilizing various software including electronic health records and on-line application processes

· Skill in assessing and prioritizing multiple tasks, projects, and demands.

· Skill in written and oral communication.

MINIMUM EDUCATION QUALIFICATION

PRC Referral Coordinator II-III

Associate-level college degree and/or certification in medical coding, accounting, or management required. Progressively responsible professional work experience may be substituted on a year-for-year basis for college education.

MINIMUM EXPERIENCE QUALIFICATION

PRC Referral Coordinator II

Non-supervisory – Two (2) years professional work experience in a clinical setting preferred; AND two (2) years’ experience in medical referrals, or other related medical patient support functions in a clinical setting. An equivalent combination of relevant education and/or training may be substituted for experience.

PREFERRED EXPERIENCE QUALIFICATION

Experience with electronic health records, spreadsheets, and database management preferred.

PREFERRED CERTIFICATION QUALIFICATION

PRC Referral Coordinator II-III

Graduate of a medical assistant program or certified medical assistant preferred.