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 supervision, screen patient eligibility and assess clinical information, referred patients to determine eligibility for State of Alaska Medicaid Travel Benefits. Assist the patient, clinic and service unit with successful evaluation and submission for patient travel benefits.

Responsibilities:

All

Conducts clinical evaluations of documentation provided by the patient, ANMC, and healthcare entities to determine eligibility for patient travel benefits under the rules and regulations of the Alaska State Medicaid

Program. Serves as the liaison between the patient, ANMC and the State of Alaska regarding Medicaid Transportation Services to prove medical necessity for a Medicaid Travel Authorization.

Must be able to communicate effectively with patients and various healthcare professional providing updates on authorization information and required documents needed to be sent to the State of Alaska. Gathers all information requested by the Alaska State Medicaid Representative by utilizing various computer systems and by communicating with ANMC or Tribal Health Partner RN Case Managers. Informs customers about other services and resources that are available to them.

Works collaboratively with other members of the team and departments, as well as outside agencies, to ensure the State of Alaska Rules and Regulations are being met while also serving as an advocate for the patient and referring provider. Will determine continued or amended eligibility in real time with all tribal travel agencies and relative accommodations.

Ensure that there is accurate documentation to prove the medical necessity of the travel authorization.

All submitted authorizations should reflect the correct CPT and diagnosis codes. All authorizations numbers should be reflective of the dates authorized and should correspond to the services authorized.

Coordinate with or assume the function of Prior Authorization, Provider Inquiry, and Claims Resolution units to ensure provider/claims resolution.

Analyze findings and advise supervisor of significant system or provider problems/concerns, work aged or other associated production reports as well as all State entities involved with provider claims.

Performs other duties as assigned or required.