PRC Technician

Kewa Pueblo Health Corporation kphc•Santo Domingo Pueblo / Kewa, NM

7d•$21 - $33•Onsite

About The Position

The Kewa Pueblo Health Corporation (KPHC) is established for the purposes of carrying out the vision and mission of the Santo Domingo Health Center (SDHC). The MISSION of KPHC is: “ENSURING HEALTH & WELLNESS THROUGH EXCELLENCE IN HEALTHCARE WITH RESPECT FOR CULTURE” and the VISION OF KPHC is: “HEALTHY PEOPLE, HEALTHY COMMUNITY, and HEALTHY LIFESTYLE”. The purpose of this position is to provide a full range of services related to contract health, business office, medical records, and clinic administration.

Requirements

High School Diploma or GED equivalent
Two or more years’ experience in duties and responsibilities specified.
KNOWLEDGE OF PROCEDURES AND REGULATIONS COVERING THE PROCESSING OF A WIDE RANGE OF DOCUMENTS UNDER THE PURCHASE REFERRED CARE (PRC) PROGRAM
KNOWLEDGE TO PROCESS DATA FROM A VARIETY OF FORMS, DOCUMENTS, AND REPORTS (E.G. MEDICAL AUTHORIZATIONS, DCR’S AND ACCOUNTING RECORDS).
KNOWLEDGE OF PRC FUNDING LIMITATIONS AND POLICIES TO ADVISE OTHERS OF PROCEDURAL AND REGULATORY REQUIREMENTS
KNOWLEDGE OF TOTAL PROGRAM, OPERATION, PRIORITIES AND GOALS OF THE ALTERNATIVE RESOURCES PROGRAM
ABILITY TO KEEP ABREAST OF CURRENT CHANGES IN POLICIES, REGULATIONS OF ELIGIBILITY, MEDICAL TERMINOLOGY AND DIAGNOSTIC AND FINANCIAL CODING
ABILITY TO PARTICIPATE IN PLANNING, IMPLEMENTATION AND IMPROVEMENTS OF THE ALTERNATE RESOURCES
KNOWLEDGE OF ESTABLISHED PROCEDURES, REQUIRED FORMS, ETC. ASSOCIATED WITH THE VARIOUS HEALTH INSURANCE PROGRAMS.
KNOWLEDGE OF THE NATURE AND CONTENTS OF PUBLICATIONS, FORMS, AND OTHER GUIDELINES OR INFORMATION MATERIAL PERTINENT TO CARRYING OUT OR COORDINATION WORK AND SPECIFIC PROGRAM ACTIVITIES.
KNOWLEDGE OF COMPUTER WORD PROCESSING AND USE OF APPROPRIATE SOFTWARE PACKAGE.
Maintain a current insurable driver’s license.
Comply with all Kewa Pueblo Health Corporation and Santo Domingo Health Center policies and procedures.

Nice To Haves

Associate’s Degree in a related field
Understanding of medical terminology.
Bilingual skills in English and the Keres native language.
Prior experience working with Indian Health Services (IHS), a Tribe or Tribal Organization.

Responsibilities

Determines patient eligibility for care under the PRC Program, requiring the application of PRC rules and regulations on PRC delivery areas. Determines patient eligibility as a prerequisite to authorization of funds and requires making accurate and independent decisions for the provision or denial of payment for services based upon eligibility criteria.
Defines alternate resources available to patients under the PRC Program and independently determines patient eligibility for Medicare, Medicaid, Veterans Administration, Medical Services, private insurance, state programs, and any other applicable resource. Possesses thorough working knowledge of various Third Parties, such as Medicare, Medicaid, Private Insurance, etc., availability of health care resources, rules of eligibility for medical and other available programs to assist in payment of health care costs. Contacts alternate resource agencies, conducts personal interviews with patient and/or family members to determine potential eligibility for any alternate resources, and works as a liaison between patient and outside provider/ resource regarding follow up care and eligibility of coverage.
Participates in determinations of reasonableness of rates by non-IHS providers and contractors of PRC by providing appropriate data and other input.
Performs patient services related to follow-up care, diagnostic procedures, and referrals to medical specialist for consultation and/or treatment. Schedules appointments and /or multiple appointments based on schedules, availability of doctors, nature of treatment and /or emergency, the logical sequence of required tests and x-rays, and the amount of travel time required by the patients.
Instructs a patient regarding necessary medical preparation prior to receiving treatment. Notifies appropriate personnel of scheduled appointments and of medical records and files required documentation. Notifies patient of medical follow-up as requested by the clinician and for cancelled and /or rescheduled clinics.
Disseminates information through proper channels in accordance with established procedures and performs other general clerical tasks necessary in carrying out patient appointment functions.
Obtains from the patient, proof of tribal enrollment for medical eligibility. Maintains sufficient health records forms, authorizations or clinic information, eligibility forms and standard forms explaining the patient's rights under the Privacy Act.
Performs technical functions related to the analyzing of medical records for completeness, consistency and compliance with requirements. Refers apparent discrepancies or inconsistencies in the records, which involve questions of interpretation of medical reference of the relationship between diagnosis and treatment to the physician for resolution.
Maintains a current checking system on each patient receiving medical care from this facility. This consists of contacting various Federal, State and County agencies to verify current eligibility for third party health insurance and their identifying numbers.
Prepares and compiles the authorization for release of medical information, assignment of benefits and pre-certification. Gathers and compiles information needed to determine benefits or benefits related health care services for all third party billing purposes and processes.
Searches and retrieves individual patient health record(s) to gather and compile information for outpatient services. Searches and gathers the clinical management of individual patient's condition and diagnosis to generate indicators of health status and health statistics from the ICD-CM coding volumes and CPT coding system.
Performs daily interviews to obtain specific demographic and insurance information in a diplomatic and confidential manner.
Plans and carries out the work of the office and handles problems and deviations in accordance with established instructions, priorities, policies, commitments and program goals of the supervisor and accepted practices in the occupation.
Reviews incoming medical bill from providers to determine if an approved referral was made and if not, collects the necessary data and paperwork for submission to the Health Center Director and IHS PRC staff for approval or denial.
Inputs daily into the computer systems PRC data, notification information, referral information, patient information, PRC denial information and any other appropriate PRC program data necessary to meet established mandatory guidelines and deadlines.
Provide technical PRC information and guidance on all inquiries. Ensures prompt follow up with appropriate personnel and vendors maintaining strict confidentiality.
Answers telephone and personal inquiries regarding payment, outstanding charges, eligibility, etc. Answers routine correspondence and compiles information and assist in the preparation of periodic and special reports concerning contract services to Area Office and Health Center Director.
Prepares routine correspondence when appropriate to patients and providers.
Enhances professional growth and development through participation in educational programs, meetings, and workshops.
Performs other related duties as assigned by supervisor.