PRC Manager/PD

Grand Traverse Band of Ottawa and Chippewa Indians•Suttons Bay, MI

About The Position

Administers and coordinates the Purchased Referred Care (PRC) Services Self-Governance Compact Health files, Forest County Potawatomi Portal, Resource Patient Management System (RPMS), software systems relevant to position as needed, and act as liaison between clients, providers, and Third-Party Administrator. This position will perform the duties of the Program Director for Purchased/Referred Care Services. In addition, this position will include Tribal Premium Sponsorship Program responsibilities, Benefits, CHR budget and PRC Transport responsibilities. Plan for TPA to FPA. Excellent customer service a must.

Requirements

Bachelor's Degree in Health Administration or equivalent education and experience.
Minimum of and Associates Degree and five (5) years of experience in Purchased Referred Care.
Minimum of five (5) years of experience with Health Database and Financial budget management skills
Must have a valid unrestricted driver license and be insurable by the GTB insurance carrier.
Must have good oral and written communication skills
Must be self-starter and have excellent organizational skills
Work requires proficiency in computer literacy, preferably in Microsoft Windows, Word, Excel, Outlook, and other Microsoft office products and database applications.
Must have good interpersonal skills with demonstrated patience, tact, and respect.
Uses good judgment in interpreting guidelines, in adapting department procedures, or in recommending approaches or solutions for specific problems
Must have outstanding verbal and written communication skills.
Must have good time management and organizational skills
Excellent interpersonal skills with demonstrated patience, tact, and respect.
Ability to work independently, with people in a group setting, and be a team player.
Exceptional detail and follow-up skills are critical.
Must have good customer service skills.
Must be reliable and maintain confidentiality.
Must have completed Program Director Training or complete within one year of hire.

Responsibilities

Maintain the FCP Portal, including client and vendor files
Maintain the computerized Voucher Management System including client and vendor files, budget management files, and computerized commitment register.
Determine eligibility for enrollment in PRC program by collecting appropriate documentation from applicants, maintaining both hard files and e-files by year for clients/patients.
Access the FCP Portal to add, change and delete contracts for clients as necessary.
Maintain data files in IHS-provided RPMS computer system to assure that credit for client contact is received by the Tribe at the national level.
Answer written and telephone inquiries from clients and health care providers on behalf of the GTB Health Department.
Adjust and approve authorizations for payment and submit payment approval requests to the accounting department.
Work with Clinic Administration Supervisor and Central Patient Registration to streamline patient eligibility/registration.
Serve as a tribal member/client advocate with area hospitals/providers.
Collaborate with Benefits Coordinator to ensure clients apply for all eligible medical benefits (i.e., Medicaid, Medicare, etc.)
Assist in determining medical eligibility and work with client to apply for Medicaid.
Tribal Premium Sponsorship Program responsibilities: Assist in determining eligibility in the Tribal Premium Sponsorship Program and work with client(s) to apply for Sponsorship, working collaboratively with the Benefits Coordinator and other Department Staff.
Must train and pass to become Certified Assistor through the Marketplace Learning Management System (MLMS) with Center for Medicare and Medicaid Services (CMS).
Maintain manual files of check copies, vouchers, contracts, and other documents pertinent to the activities of the health program.
Assure the proper classification of voucher and other commitments or expenditures in order to facilitate the preparation of monthly reports for submission to IHS Compact.
Assist in preparation of monthly report package.
Obtain periodic training and upgrading as appropriate to maintain professional skills and stay current in modern health issues.
Comply with Privacy Act regulations as specified in the IHS contract.
Attend Tribal Council and Health Committee meetings when necessary, and provide assistance and advice as requested.
PRC Claims focus and tasks include researching claims information for clients, vendors, and Providers utilizing the FCP, RPMS, and paper files, and include eligibility as well.
Other duties as assigned that relate to the health needs of the membership and the IHS Compact/Annual Funding Agreement.
Other duties as assigned.