PRC Specialist/Referral Coordinator

COMANCHE NATION - INDIAN TRIBE•Lawton, OK

1d•$20 - $26

About The Position

Coordinates and manages Purchased/Referred Care (PRC) and specialty referral processes for patients served by Red Berry Health System. Ensures referrals are appropriate, authorized, documented, and tracked in compliance with applicable federal, tribal, and program requirements while supporting timely access to medically necessary care.

Requirements

High school diploma or equivalent required.
At least two (2) years of experience in referral coordination, PRC, case management, medical office administration, or related healthcare role preferred.
Knowledge of referral coordination, authorization processes, and medical documentation requirements.
Strong organizational, time-management, and attention-to-detail skills.
Strong interpersonal and communication skills.
Ability to work collaboratively with providers, staff, patients, and external partners.
Proficiency with Electronic Medical Records and basic computer applications (word processing, spreadsheets, internet).
Must comply with Comanche Nation policies and procedures
Must maintain confidentiality of sensitive information

Nice To Haves

Associate degree or certificate in healthcare administration, medical assisting, or related field preferred.
Experience working with tribal health programs, PRC processes, or third-party payers preferred.
Familiarity with PRC or specialty referral workflows preferred.

Responsibilities

Coordinates PRC and specialty referrals in accordance with applicable policies, procedures, and eligibility requirements.
Reviews provider referrals for completeness, medical necessity, and required documentation prior to submission.
Prepares and submits referral requests, authorizations, and supporting documentation to PRC programs, specialists, and external facilities as required.
Tracks referral status from initiation through completion, ensuring follow-up and continuity of care.
Communicates referral requirements, authorizations, and appointment information to patients, families, providers, and external referral partners.
Maintains accurate and timely documentation of referrals, authorizations, denials, and outcomes in the electronic medical record and tracking systems.
Coordinates closely with providers, nursing staff, and care teams to support appropriate referral utilization and patient care planning.
Monitors referral timeliness and identifies barriers to access, escalating issues as appropriate.
Maintains compliance with HIPAA, patient confidentiality requirements, and Comanche Nation policies.
Assists with reporting, audits, and data requests related to PRC utilization and referrals as needed.
Performs other position-related duties as assigned.