Position Summary:

You will be responsible for all prior authorizations, DME, and DAP needs by communicating with insurance companies, DME companies, medical supply companies, and pharmacies to ensure a smooth backend process for the patient. Your ability to quickly and effectively coordinate requests will ensure that our patients have a positive experience with KCHC. In order to be successful, you need to be an independently driven and accountable individual.

Essential Job Functions:

Acts as a member of the KCHC Healthcare Team in the provision of health services to individuals, families, and/or their communities. Works collaboratively with patients and their caregiversto the extent preferred by each patientas well as with other members of the KCHC Healthcare Team to accomplish shared goals within and across settings to achieve coordinated, high-quality care.

Processes prior authorization requests for all patient needs (Medication, Imaging, Labs, Procedures, Specialty Care) by contacting insurance carriers via internet, phone and fax.

• Verify patient eligibility and benefits.
• Determine insurance and pharmacy requirements to obtain approval.
• Responsible for obtaining all the necessary documentation, insurance information, and any other data needed for authorization purposes.
• Ensure timely response and initiation of prior authorization requests, consulting patient record and other resources as needed.
• Addressing insurance denials.

Processes durable medical equipment (DME) requests by contacting insurance carriers and DME supply companies via internet, phone, and fax.

• Verify patient eligibility and benefits.
• Determine insurance and DME company requirements to obtain approval.
• Responsible for obtaining all the necessary documentation, insurance information, and any other data needed.
• Ensure timely response and initiation of requests, consulting patient record and other resources as needed.
• Addressing insurance denials.

Processes medical supply requests by contacting insurance carriers and medical supply companies via internet, phone, and fax.

• Verify patient eligibility and benefits.
• Determine insurance and supply company requirements to obtain approval.
• Responsible for obtaining all the necessary documentation, insurance information, and any other data needed.
• Ensure timely response and initiation of requests, consulting patient record and other resources as needed.
• Addressing insurance denials.

Maintains the Drug/Prescription Assistance Program

• Assisting patients through the process from pre-qualifying, applying, receiving medications and ordering refills as requested by the physicians.

• Follows the guidelines of each individual pharmaceutical companys requirements.

Imaging/Lab resulting.

• Maintains overdue imaging pool.
• Assists and coordinates travel logistics for on and/or off island appointments as indicated.

Requests travel authorizations for patients with Medicaid.

• Assists patients with travel process/reimbursement for private insurances.
• Offers Angel Flight air travel assistance program to patients in need.
• Assists when necessary with coordination and scheduling of medical appointments for KCHC patients referred to medical and/or behavioral health care providers.

1. Document patient information in the medical record using standard operating procedures and meeting appropriate timelines.
2. Drive communication with clinic staff, patients, third-party payers, medical equipment/supply companies, and dispensing pharmacy to provide exemplary customer experience and ensure all payer requirements are met.
3. Provide superior customer service to all internal and external customers.
4. Excellent phone and computer skills.
5. Maintains a positive work environment.
6. Maintains confidentiality by complying with HIPAA standards.
7. Performs other related duties, as assigned, that support the overall mission and vision of Kodiak Community Health Center.

Essential Job Qualifications:

Education: High school diploma/GED required.

Experience: Excellent phone and computer skills are required. Knowledge of medical terminology is preferred.

Licensure/Certification: None required.

Other Qualifications:

Communication:

• Ability to effectively communicate, verbally and in writing, with all levels of staff personnel.
• Strong analytical skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy.

Collaboration:

• Team-oriented and able to work collaboratively with staff.
• Strong problem-solving and time-management skills.
• Ability to work independently in a fast-paced medical office environment with frequent interruptions, public contact, and occasional crisis situations.
• Ability to maintain strict confidentiality with sensitive medical information and foster an ethical work environment.
• Ability and willingness to carry out responsibilities in accordance with the organization's policies and applicable laws.

Cultural Competence:

• Demonstrates complete understanding and responds effectively with sensitivity to special populations served by KCHC. Special populations include, but are not limited to, those defined by race, ethnicity, language, age, sex, sexual orientation, economic standing, disability status, migrant, homelessness, seasonal workers, and the uninsured.

Attendance:

• Regular attendance and punctuality is expected and required.

English Language:

• Must be able to read, write, and speak English.