PRC Technician-Arcata-closes 10/20/26

United Indian Health Se•Arcata, CA

13h•$27 - $34•Onsite

About The Position

The Purchased Referred Care (PRC) Technician is responsible for initiating, tracking, and processing "payer of last resort" health insurance claims in accordance with United Indian Health Services (UIHS) Purchased Referred Care (PRC) guidelines. This role involves maintaining accurate PRC files, determining the eligibility of PRC referrals and emergency care notices based on UIHS approved priorities, and preparing and following up on all referrals, including those requiring medical and dental review. The technician will also assess client eligibility for PRC, refer clients to Alternate Resources for screening and application if necessary, and request necessary documentation for PRC files. Additionally, the position requires contacting outside providers for charge estimates, creating purchase orders for eligible referrals, and communicating with outside agencies, provider offices, and clients regarding referral status, claim processing, and other requirements. The technician will also liaunt with UIHS providers to clarify PRC referrals, track PRC cases from appointment to final claims payment, and submit purchase orders or claims to Humboldt Independent Practice Association (IPA) for payment processing. The role includes preparing and submitting Catastrophic Health Emergency Fund (CHEF) cases according to IHS guidelines and notifying supervisors of potential CHEF cases. Regular reporting on claims reviewed, pending, and processed, as well as running monthly and miscellaneous reports, is also a key responsibility. The PRC Technician will attend PRC-related meetings and is expected to learn about American Indian culture, attend cultural presentations/trainings annually, and demonstrate cultural awareness and humility when working with American Indian/Alaska Native people, delivering services in a culturally responsive manner and adhering to accreditation and compliance standards.

Requirements

High school diploma or general education diploma (GED).
Intermediate personal computer skills, including electronic mail, routine database activity, word processing, spreadsheet, graphics, etc.
Ability to learn and work with the electronic health record and practice management systems.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to write reports, business correspondence, and procedure manuals.
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to define problem, collects data, establishes facts, and draw valid conclusions.
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Demonstrated commitment to the provision of culturally sensitive counseling services to American Indians.
Must have or be able to obtain BLS certification within six months of hire and maintain such.

Nice To Haves

0-1 years of clerical office or related experience that indicates the ability to learn the skills necessary to perform the duties of the position (Level I).
1-2 years of experience working with PRC or other related areas (Level II).
Knowledge of PRC and able to perform the duties of the position (Level II).
Ability to work independently and as part of a team (Level II & III).
Experience in a health care setting preferred (Level II).
Able to train level I (Level II).
3 or more years of experience in PRC or related areas and have the ability to perform all the duties of the position (Level III).
Experience in health care setting required (Level III).
Able to train level I or II (Level III).

Responsibilities

Maintains PRC files accurately.
Determines if incoming PRC referrals and emergency care notices are within the UIHS approved priorities, seeking assistance from the PRC Supervisor when needed.
Prepares and follows up on all referrals, including those requiring medical and dental review at the Managed Care Committee.
Determines if clients meet PRC eligibility requirements, including referral to Alternate Resources for screening and application if eligible.
Requests a copy of approved tribal documentation if necessary for the PRC file.
Contacts outside providers to request an estimate of charges.
Creates purchase orders for eligible approved referrals.
Communicates and corresponds with outside agencies, provider offices, and clients regarding approved, pending or denied referrals, claim status and other requirements.
Communicates and corresponds with UIHS providers to clarify PRC referrals.
Tracks PRC cases through the processes of: appointment, outcome, third party insurance eligibility determination, and final claims payment processing.
Communicates, tracks and submits purchase orders, or claims to Humboldt Independent Practice Association (IPA) for payment processing.
Prepares and submits Catastrophic Health Emergency Fund (CHEF) cases following guidelines from IHS.
Notifies supervisor of possible pending CHEF cases so they can be reported to the Member Services Manager and Chief Financial Officer.
Prepares periodic reports on claims reviewed, pending, and processed to completion.
Runs monthly reports, exports, and other miscellaneous reports as needed.
Attends and participates in PRC related meetings at both Board and Administrative levels as needed.
Willing to learn more about the American Indian culture and attend at least one Cultural Presentation/Training per year.
Willing to work with American Indian/Alaska Native people and demonstrate cultural awareness and humility.
Willing to deliver services in a culturally responsive manner.
Adheres to accreditation and compliance standards/guidelines.
Performs other duties as assigned.