PRC Representative

POSITION SUMMARY:

In coordination with all NVIH departments, the PRC Representative assists patients in obtaining needed services and payment sources that are appropriate, accessible and acceptable to the patient. This position also maintains the PRC process; and coordinates the on-site EHR systems of data input and reports. ESSENTIAL JOB FUNCTIONS: The list that follows is not intended as a comprehensive list, but rather to provide a representative summary of the major duties and responsibilities. Incumbent(s) will be required to perform a variety of duties listed, including but not limited to:

1. Perform initial outreach activities, conduct interviews with patients to determine potential eligibility for any alternate resources. Inform and educate patients of potential alternate resources.

2. Arrange for patient transportation services if needed.

3. Obtain written permission from patients if necessary to speak to agencies on the patients’ behalf; representing them and advocating for their needs.

4. Enter all referrals, PRC denials, deferrals and appeals into the appropriate EHR package.

5. Process all prior authorizations as required

6. Seek guidance and direction from PRC Manager as necessary for the completion of duties and in situations that exceed abilities.

7. Attend all meetings, training and conferences, as required.

8. Coordinate payment discount programs (HealthSmart, 340B, etc.) for PRC patients.

9. May be required to travel within the local communities

10. Verify all new Native American patients for registration. Maintain the EHR Registration database regarding patient eligibility.

11. Review all incoming claims for assigned clinic site from outside vendors for accuracy and prompt payment or denial of requested services. Verify program eligibility for each service requested.

12. Perform other duties as assigned.
Experience and Skills:

REQUIRED QUALIFICATIONS

The following knowledge, skills, and abilities are required for an employee to successfully perform their duties.

1. High school graduate, GED, with three (3) years of Health Records experience

2. Ability to use electronic health records and maintain current, accurate medical records, charts and health plans. Familiarity with Microsoft applications, such as Outlook, Excel, Word, & Teams.

3. Experience with the electronic health records preferred.

4. Able to organize, adapt and prioritize daily tasks independently.

5. Demonstrates collaborative teamwork in a respectful manner with various levels within as well as outside of the organization.

6. Excellent communication, interpersonal and relationship-building skills.

7. Proven ability to provide excellent customer service by anticipating customer needs and leaving them feeling satisfied with their experience.

8. Skill in establishing and maintaining positive and effective working relationships with clinic managers, patients and others contacted in the course of the work.

9. Commitment to maintain confidentiality as it relates to patients and co-workers.

10. Sensitivity to those with different life styles and to the Native American culture.

11. Adaptability to learn new concepts to enhance knowledge and customer experience.

12. Ability to obtain Covered California Certified Enroller Counselor certification within 1 year

13. Reliable transportation required to engage in regular attendance.
Job Benefits:

• Medical, Dental and Vision coverage
• Long-Term Disability and Life Insurance
• 14 paid Holidays
• Generous PTO Accrual
• 401k Retirement plan w/ employer match