Purchased and Referred Care Authorization Specialist

Purchased and Referred Care Kodiak, AK, US Category:

Purchased and Referred Care Employee Type:

full-time | non-exempt Salary range: $20.22 to $30.32 Hour All KANA positions are based in Kodiak and are not eligible for remote work. Applicants must reside in Kodiak or be willing to relocate. KANA's standard work schedule is 37.5 working hours per week, typically consisting of 7.5 paid working hours per day plus a one-hour unpaid lunch break (total of 8.5 hours on site per day). The Purchased and Referred Care (PRC) Authorization Specialist is responsible for reviewing, processing, and documenting PRC referrals and associated claims to determine patient eligibility and funding criteria for referred care services. This role supports the PRC team through accurate assessment, recordkeeping, and coordination with internal and external partners to ensure compliance with PRC policies and procedures. Essential Duties and Responsibilities The following duties are not intended to serve as a comprehensive list of all duties performed by this position. Other duties may be assigned. Supports the organization's mission and goals, quality standards, and patient-centered medical home philosophy. Embraces KANA's culture of serving the whole person through our provision of services. Incorporates KANA's core values of Courtesy, Caring, Respect, Sharing, and Pride in all activities and decisions. Upholds KANA's Code of Ethics by conducting professional activities with honesty, integrity, respect, fairness, and good faith in a manner that reflects positively upon the organization. Reviews referrals to determine PRC eligibility. Utilizes Cerner to verify service need, referral location, patient eligibility, and required documentation. Conducts research to confirm eligibility for each referral. Adheres to all Finance requirements and processes for purchase and payment processing. Notes alternate insurance coverage to bill prior to KANA (payer of last resort). Includes stipulations for patient action (e.g., Medicaid application requirements). Applies limits to requisitions, including: Dates of service, Number of visits, and Value of visits. Prepares denial documentation as applicable. Uploads approval or denial letters into Cerner and attaches to the appropriate referral. Reassigns completed referrals with documentation to the Referred Care Coordinator for further processing. Records all decisions in patient files in Cerner. Communicate with Patient Benefit Coordinators regarding uninsured patients. Participates in relevant training related to PRC, billing, and coding. Occasional travel may be required.

Supervisory Responsibilities:

This job has no supervisory responsibilities Requirements High school diploma or general education degree (GED) and two years' experience working with the public in an office setting; or equivalent combination of education and experience. Familiarity with federal, state and local resources available to meet the health and social needs of patients preferred. Knowledge of medical billing procedures, medical terminology, HIPAA, and other state and federal regulations governing healthcare practices.