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.
ANTHC offers a competitive and comprehensive Benefits Package for all Benefit Eligible Employees, which includes:

• Medical Insurance provided through the Federal Employee Health Benefits Program as a Tribal Employee, with over 20 plans and tiers.
• Cost-Share Dental and Vision Insurances
• Discounted Pet Insurance
• Retirement Contributions with Pre-Tax or Roth options into a 403(b).
• Retirement Match and Discretionary. ANTHC matches up to 5%, with a 3% discretionary contribution after one year of employment into a 401(a).
• Paid Time Off starts immediately, earning up to 6 hours per pay period, with paid time off accruals increasing based on years of service.
• Twelve Paid Holidays
• Paid Parental Leave or miscarriage/stillbirth eligibility after six months of employment
• Basic Short/Long Term Disability premiums, Accidental Death and Dismemberment (AD&D) Insurance, and Basic Life Insurance are covered 100% by ANTHC, with additional options for Short-Term Disability Buy-Up - - Coverage and Voluntary Life for yourself and your family members.
• Flexible Spending Accounts for Healthcare and Dependent Care.
• Ancillary Cash Benefits for accident, hospital indemnity, and critical illness.
• On-Site Child Care Facility with expert-designed classrooms for early child development and preschool.
• Employee Assistance Program with support for grief, financial counseling, mental/emotional health, and discounted legal advice.
• Tuition Discounts for you and your eligible dependents at Alaska Pacific University.
• On-Site Training Courses and Professional Development Opportunities.
• License and certification reimbursements and occupational insurance for medical staff.
• Access to Alaska Pacific University includes a salt water pool, rock climbing, workout gym, and steep discounts for outdoor equipment rentals.
• Emergency Travel Assistance
• Education Assistance or Education leave eligibility
• Discount program for travel, gym memberships, amusement parks, and more.

Visit us online at www.anthc.org or contact Recruitment directly at HRRecruiting@anthc.org.
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.
SummaryUnder general direction facilitates continuous purchased/referred care process improvement within the Purchased Referred Care (PRC) department. Coordinates referral authorization, claims adjudication, and follow-up activities.
Responsibilities

• Assists in managing the day to day operations of PRC.
• Responsibility over referral authorization, claims processing, patient/provider appeals, referred care information systems operations and claims applications within the PRC Department.
• Focuses on attaining PRC goals, while facilitating continuous process improvement, maintains compliance with all federal requirements.
• Works with Director and to develop, plan, and implement PRC goals and objectives that are consistent with the overall strategic plan of ANTHC. Coordinates system-wide activities of ANTHC’s PRC Department and key stakeholders.
• Works to ensure compliance with requirements for the PRC Program.
• Develops, maintains, and continuously improves the departmental training curriculum for new hires, incumbents, and supervisory development.
• Counsels, mentors and coaches PRC staff as required.
• Assures completion of PRC work in a timely manner to meet regulatory and compliance requirements, while meeting or exceeding ANTHC PRC goals.
• Assists in maintaining records of denials and appeals, along with relevant documentation.
• Complies supporting documentation and drafts executive summaries in final appeals for the Director and CEO.
• Support PRC information system initiatives.
• Represents the department on committees related to current and future computer systems and their operations.
• Responsible to assure appropriate productivity and customer relationships.
• Assists in maintenance of Quality Improvement Program for PRC.
• Makes recommendations and manages implementation of change throughout and within PRC department.
• Manages special projects as required. Compiles and analyzes data. Prepare, review, analyze and distributes a variety of files, records, reports, and other documents.
• Provides leadership, direction, and guidance to assigned staff. Develops goals and priorities in conjunction with employees, and assigns tasks and projects.
• Develops staff skills and training plans. Counsels, trains, and coaches subordinate staff. Implements corrective actions and conducts performance evaluations. Maintains the confidentiality of patient records and procedures.
• Completes internal and external written and oral reports professionally and in a timely manner. Coordinates with ANTHC finance department to insure timely and accurate financial reporting.
• Additional duties as assigned.

Other InformationKNOWLEDGE and SKILLS

• Knowledge of privacy laws and regulations including health care compliance laws and regulations related to the Purchased Referred Care program.
• Knowledge ICD-10 coding, CPT coding, and advanced medical terminology
• Knowledge and experience of a broad base of health care billing principles including coordination of benefits, Medicare-like-rates, and timely filing requirements.
• Knowledge of physician practice operations and physician practice reimbursement principles.
• Knowledge of hospital operations and ANMC Policy & Procedures related to Purchased Referred Care, in order to ensure policies are followed.
• Knowledge of referred care and claims adjudication information systems.
• Skill in customer service concepts and principles.
• Skill in establishing and maintaining cooperative working relationship with others.
• Skill in assessing and prioritizing multiple tasks and facilitating projects and work teams.
• Skill in analytical, oral, and written communication as well as analysis and presentation.
• Skill in high level revenue cycle information technology.
• Skill in project management including ability to bring projects in on time and under budget.
• Skill in presenting financial and process information to boards, physicians and executives.
• Skill in effectively managing staff, mentoring staff, delegating tasks and delegating authority.
• Skill in developing departmental policies and procedures.

MINIMUM EDUCATION QUALIFICATION
A Bachelor’s Degree in business, finance, or health related discipline. Progressively responsible related work experience may be substituted on a year-for-year basis for college education.
Minimum Experience QualificationNon-supervisory – Four (4) years of medical finance or business office or related referral and claims management experience, including substantial experience as a “super user” of claims adjudication information systems and health care financial management or revenue cycle management or business office management experience.
AND
Supervisory – Two (2) years involving employee supervision.