What are the responsibilities and job description for the Purchased Referred Care Technician PRC position at Warm Valley Health Care?
GENERAL STATEMENT:
The purpose is to provide clerical assistance and support to the PRC department. Entering data in different software, assisting with referrals to be submitted to outside providers. Responsible for submitting proper documentation to insurance entities for prior authorizations.
DUTIES AND RESPONSIBILITIES:
- Perform clerical assistance including requesting documents from providers, reviewing primary insurance status.
- Initiates and distributes medical authorizations determining patient eligibility for direct and contract services.
- Maintaining a tracking system for high-cost case management of cases for CHEF funds.
- Maintains denial correspondence files assuring that all appropriate documentation is included in file.
- Conducts on-site patient interviews to establish eligibility and verifies records of residence for applications.
- Verifies contract health eligibility for Indian patients using CHS regulatory criteria and also determines patient eligibility for third-party alternate resources.
- Participates in CHS review committee meetings.
- Manage profiles, including updates, consents, and other important information.
- Responsible for maintaining accurate documents required to complete referrals requiring prior authorizations.
- Provides information in person or by telephone regarding services available under Warm Valley Health Care.
- Responds to PRC inquiries and requests for PRC assistance. Such responses are through telephone, correspondence, and personal visits with consumers.
- Develops and maintains a positive working relationship and supports the overall team effort of WVHC.
- Verifies all alternate resource data necessary for patient and third-party payers; verifies insurance coverage; obtains signatures for file on forms for alternate resources.
- Performs routine clerical duties assisting in outgoing referrals and their status.
- Enters client data into the appropriate database; maintains accurate files, and organizes data.
- Maintains the strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Performs other related duties as assigned.
QUALIFICATIONS:
- High School or GED
- Experience (3 years) as a clerk or receptionist in a medical or business setting.
- Experience with Electronic Health Record (EHR) software preferred.
- Incumbent must possess the ability to interact with a wide variety of individuals and handle complex situations.
- Requires impeccable communication and negotiation skills, written, and verbal, and excellent computer skills. Must be able to apply critical thinking through the changing work environment.
- Culturally sensitive to Native Americans
- Self-motivated
- Must be able to prioritize work tasks and can be creative with projects.
- Must be able to fully utilize a computer.
- Must be able to perform duties with a minimum of supervision.
BENEFITS:
- Medical (F.E.H.B.)
- Dental, Vision, and Supplemental Insurance Plans
- $50,000 Life Insurance (Employer Paid)
- Short-term Disability (Employer Paid)
- Paid Vacation, Sick Leave, Personal Leave, and Holiday Leave
- 401k Retirement Plan (5%Match)
Salary : $50,000
