Medicaid Prior Authorization Specialist I
The vision: Through Native Self-Determination and Culturally Relevant Health Systems, we strive to be the healthiest people.
At the Yukon-Kuskokwim Health Corporation (YKHC) we administer a comprehensive healthcare system throughout 58 rural communities with a mission of Working Together to Achieve Excellent Health.
YKHC serves 58 federally-recognized Tribes and operates 41 Village Clinics. Our five larger communities are served by five Sub-Regional Clinics. All communities in our service area are served by the 55 bed regional hospital in Bethel.
For more information about our hospital or the region please visit
Yukon-Kuskokwim Health Corporation - We Strive to be the Healthiest People (www.ykhc.org)
Medicaid Prior Authorization Specialist I under normal supervision, assists in providing transportation/logistical assistance to Alaska Medicaid Recipients traveling to and from the Yukon Kuskokwim Health Corporation (YKHC) service area by determining if the burden of medical necessity has been met by documenting these findings in detail through the appropriate computer systems.
Level 1 employees perform work under close supervision, may only perform simple or routine aspects of the position, and generally require a good deal of instruction and/or training. Senior lead employees perform high level, complex and responsible tasks within this position and generally work with minimum supervision and follow-up from their supervisor.
The following duties are intended to provide a representative summary of the major duties and responsibilities and ARE NOT intended to serve as a comprehensive list of all duties listed and may be required to perform additional, position-specific duties.
For Medicaid eligible patients and/or escorts, works with clinical providers to determine if medical necessity has been met prior to transportation services. Also, serves as the liaison between the YKHC and the State of Alaska regarding Medicaid Transportation Services. Gathers all information requested by the Alaska State Medicaid Representative by utilizing various computer systems and by communicating to all parties involved so that all prior authorization requests can be handled in a timely manner.
Work collaboratively with patient on eligibility issues. Must be knowledgeable about when to refer patient to the YKHC Medicaid Enrollment department and/or Alaska Division of Public Assistance (DPA) to move authorization along in an expeditious manner.
This position will draw upon experience and general knowledge; will review documentation or contacts the provider or requestor when necessary in order to prove medical necessity for the authorization.
This position will also ensure that there is appropriate 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.
This position will coordinate with or will assume the function of Prior Authorization, Provider Inquiry and Claims Resolution units to ensure provider/claims resolution.
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