Purchased Referred Care (PRC) Claims Technici

Great Plains Tribal Leaders Health•Rapid City, SD

3d•$21 - $26•Onsite

About The Position

The Purchase Referred Care (PRC) Claims Technician is responsible for repricing outside vendor claims according to federal guidelines and Oyate Health Center (OHC) PRC policies. This role utilizes RPMS, EHR, and repricing software to analyze and reprice vendor claims to Medicare-Like Rates. The position involves gathering patient demographic information, determining eligibility, maintaining Alternate Resources data, reviewing claim forms for accuracy, communicating claims outcomes, and ensuring timely payment of claims. Effective communication with vendors and finance staff is crucial, as is the ability to manage and store files, stay updated on CMS changes, and provide reports as needed. The technician will also maintain necessary forms, participate in performance improvement teams, and comply with HIPAA regulations.

Requirements

Associate degree and one (1) year of relevant administrative office support; or a high school diploma or equivalent and three (3) years of relevant administrative office support experience sufficient to understand the major duties of the position.
Demonstrated efficient organizational skills and successful completion of tasks under continuing pressure to meet deadlines.
Must successfully pass a criminal and background check and a pre-employment drug screen.
Compliance with our Employee Health Procedure is a condition of employment. You are required to agree that you will comply with all job-related employee health screening and immunizations prior to your first day of employment.
Jobs require that you have documentation that you have completed the following immunizations prior to your first day of employment: MMR (Measles, Mumps and Rubella, Varicella (Chicken Pox), Hepatitis B, Influenza, T-dap (Tetanus - Diphtheria - Pertussis), and COVID-19 vaccination is required.
This position requires the ability to perform the essential functions of the job, with or without reasonable accommodation.

Nice To Haves

Purchase Referred Care experience
One (1) year coding experience

Responsibilities

Answers telephone and greet visitors; provides information and assistance; and resolves problems.
Gathers patient demographic information, updates patient information, and determines eligibility for services; and obtains documentation of Indian blood or other documentation of Tribal membership and proof of residency, when necessary.
Maintains, key-enters, updates, and verifies all Alternate Resources data necessary for patient registration and for accurate billing, and makes corrections as necessary to improve the Purchased Referred Care process.
Reviews UB-04 and CMS 1500 claim forms for accuracy and completeness.
Re-prices all clean claims utilizing appropriate software.
Communicates claims outcomes to vendors and patients.
Works with finance staff to ensure claims are paid in a timely manner.
Maintain effective communication techniques between PRC and outside vendors.
Save all repriced claims; be familiar with shared file methods and how to store, manage and share files.
Stay abreast of CMS changes in Fee Schedules and PC Price guidelines.
Provides reports in accordance with established schedule and format as requested.
Maintains an adequate supply of required forms/documents.
Participate in performance improvement teams and other committees as assigned.
Must comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA).
Performs related duties.
Performs the core responsibilities of the position accurately, timely, and in accordance with established standards.
Maintains regular and reliable attendance consistent with the position’s schedule and operational needs.
Communicates effectively with internal and external stakeholders as required by the role.
Adheres to all applicable policies, procedures, and regulatory requirements.
Utilizes required systems, tools, and technology necessary to perform the job.