CTHCA PRC Referral Clerk (TM48049)

CONFEDERATED TRIBES OF THE COLVILLE RESERVATION•Coulee City, WA

4d•$21 - $26•Onsite

About The Position

The Referral Clerk provides administrative support to the Purchased/Referred Care (PRC) program by processing and tracking patient referrals to external healthcare providers. This role involves coordinating with patients, providers, and insurers to ensure appropriate documentation, eligibility, and follow-up for referred care services. The Referral Clerk ensures compliance with PRC policies, Indian Health Service (IHS) regulations, and tribal healthcare standards. The Referral Clerk position is distinguished by its focus on managing external healthcare referrals within the PRC system. It requires knowledge of PRC regulations, HIPAA compliance, and medical terminology. This role is critical for ensuring timely and efficient coordination of off-site patient care services.

Requirements

High School Diploma or GED required.
Two (2) years of experience in a healthcare office, referral coordination, or medical records preferred.
Experience with PRC or IHS systems highly desirable.
Valid driver’s license and ability to pass a background check.
HIPAA certification or willingness to obtain.
CPR certification preferred.
Knowledge of PRC policies, IHS referral protocols, and tribal health system practices.
Familiarity with medical terminology, billing codes, and insurance verification.
Proficiency in Microsoft Office and EHR systems.
Strong organizational skills and attention to detail.
Effective communication and customer service skills.
Ability to manage multiple referrals and follow up in a timely manner.
Ability to maintain confidentiality and adhere to HIPAA regulations.
Ability to communicate effectively with patients, staff, and external providers.
Ability to work both independently and as part of a team.
Ability to adapt to changing procedures and program requirements.
Valid driver’s license and ability to pass a background check.
HIPAA certification or willingness to obtain.
CPR certification preferred.
Must adhere to infection control and safety protocols.
Ability to travel occasionally for training or program coordination.

Nice To Haves

Two (2) years of experience in a healthcare office, referral coordination, or medical records preferred.
Experience with PRC or IHS systems highly desirable.
HIPAA certification or willingness to obtain.
CPR certification preferred.

Responsibilities

Receive and review referral requests for completeness and eligibility.
Enter referral data into the Electronic Health Record (EHR) and PRC tracking systems.
Coordinate appointments with external providers, ensuring patient notification.
Verify patient eligibility for PRC services and confirm insurance status.
Maintain organized records of all referrals and authorizations.
Follow up with providers and patients regarding referral status.
Collaborate with PRC and billing staff to ensure accurate documentation and payment processing.
Adhere to confidentiality standards and HIPAA regulations.
Support quality improvement efforts and reporting as needed.
Work is typically performed in a clinical office environment.
May involve interaction with patients who are distressed or frustrated.
Occasional travel for training or meetings may be required.
Performs other duties as assigned