Purchased Referred Care Coordinator

Position Summary: This position is responsible for determining patient eligibility for PRC based on Indian Health Service guidelines, maintain and implement PRC policies and procedures established by the Board of Directors, authorize and coordinate payment for services provided, submit cases to appropriate agencies for additional funding or reimbursement, prepare various reports as required.

Specific Duties and Responsibilities:

1. Maintain and implement P/RC policies and procedures established and approved by the Board of Directors, using the Indian Health Service guidelines as a reference.

2. Supervises the P/RC Department staff and delegates duties as needed.

3. Work directly with patients as needed to inform them about P/RC program details and help guide them through the process. Work with patients and other PRHS staff to help to constructively resolve patient issues with the P/RC program. Interact with all patients with a positive, customer service-oriented attitude.

4. Review information provided by the patient to determine eligibility for P/RC as established under the guidelines.

5. Receive and document 72-hour/30-day for elders notices for emergency room visits in RPMS system and notify appropriate staff.

6. Enter accurate patient information into the RPMS computer system.

7. Maintain communication with Intake Coordinator and Family Service Worker on status of Alternate resources for patients.

8. Conduct weekly P/RC Committee meetings and record the minutes.

9. Coordinate appointments with vendors and patients, arrange transportation when needed.

10. Prepare necessary correspondence to patients and vendors.

11. Prepares and process denial letters within time limits noted in the PRC policy.

12. Provide training and orientation to the P/RC Clerk and vendors to insure the coordination of billing and payment of outside services.

13. Submits P/RC Purchase Orders to Business Office Manager to review.

14. Processes authorization of new prescriptions ordered and refills of existing. Maintain coordination with PRHS contract pharmacies for efficient and effective processing of prescription orders.

15. Participate with Business office Manager for coordination and maintenance of PRHS 340B discount program.

16. Establish Memorandums of Agreement with current vendors for contracted care. Seek discounted rates wherever possible. Maintain binder containing all signed agreements.

17. Assist with necessary actions to ensure compliance of patients and participating vendors.

18. Maintain accurate P/RC Obligation Register of documents issued, amounts obligated, corrected, canceled or paid and current un-obligated balance.

19. Prepare various statistical reports as required.

20. Submit eligible cases as they arise to IHS for reimbursement from the Catastrophic Health Emergency Fund (CHEF).

21. Participate in staff development and in-service training activities.

22. Reporting incidents- Refer to policy and procedures.

23. Other fiscal duties as assigned by Supervisor.

Required Qualifications:

1. High School diploma required, and a 2-year associate degree and/or equivalent education desired.

2. 3-5 years’ experience in healthcare office management desired.

3. Knowledge of medical terminology, diagnosis coding, and medical billing procedures.

4. Knowledge of IHS P/RC guidelines, policies and procedures.

5. Knowledge of availability and utilization of alternate resources such as Medicare, Medi-Cal, Covered Ca and private insurance.

6. Organizational skills and ability to maintain accurate records and filing systems.

7. Ability to type 45 WPM accurately and use 10-key calculator by touch.

8. Strong written, oral and interpersonal communication skills.

9. Data entry, word processing and basic computer skills.

10. Ability to maintain strict confidentiality of records and information.

11. Must be Customer Service Oriented.

12. Ability to cross train within department.

13. Preference will be given to Native Americans in accordance with P.L. 93-638.

14. Must be willing to submit to and pass a pre-employment drug test and physical clearance.

15. Possess a current CPR card.

Job Type: Full-time

Pay: From $21.54 per hour

Expected hours: 40 per week

Benefits:

• 403(b)
• 403(b) matching
• AD&D insurance
• Dental insurance
• Health insurance
• Life insurance
• Paid sick time
• Paid time off
• Paid training
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: In person

Salary : $22