Purchased/Referral Care Resource Coordinator

Tule River Indian Health Center Inc • Porterville, CA

8h • $21 - $27 • Onsite

About The Position

Under the direction and supervision of TRIHCI’s PRC Officer, the PRC Resource Coordinator is responsible for the coordination of all assigned patient referrals and medical specialty services, including referrals to hospitals, hospices, home health services, dental services, etc. In this capacity, the PRC Resource Coordinator is responsible for obtaining prior authorization when needed, and common workflow responsibilities will also include monitoring referrals, generating purchase orders, and processing bills for payment with proper medical coding. Consequently, this position requires someone who is an independent worker yet remains committed to a team-orientated approach. He/she must be sensitive to the needs of the Indian community; its cultures, traditions and values and express a genuine enthusiasm for its well-being.

Requirements

• Possess strong organization competencies, particularly in the areas of records management and patient registration.
• Demonstrate excellent interpersonal skills and the ability to interact effectively with a wide variety of individuals.
• Demonstrates functional understanding of alternative resources identification and utilization.
• Possess basic knowledge and skill in EHR software and database management.
• Demonstrate basic levels of computer literacy, with a functional understanding of Microsoft Windows Operating Systems in an office setting.
• Maintain a basic knowledge of ICD-10 and CPT coding, as well as basic medical terminology.
• Demonstrate dependability and punctuality in carrying out work assignments.
• Must have the ability to work under pressure in dealing with multiple tasks and constant deadlines, while maintaining attention to detail and accuracy.
• Must have good communication skills and be able to effectively communicate with diverse populations.
• Demonstrate the ability to work independently in carrying out assignments while remaining reliable and dependable.
• Possess the ability to perform well in group problem-solving situations and use reason even when dealing with highly emotional topics.
• Possess the ability to become knowledgeable of health needs and services provided to the Indian community both on and near the reservation.
• Demonstrate the competency and integrity to maintain the confidentiality of organizational, employee, and client records.
• A high school diploma or GED-equivalency is required for this position.
• Three (3) years prior experience in an ambulatory health care setting is also required.
• A current California driver’s license, a good driving record, and BCLS certification are required for this position or must be obtained with 3 months of employment.

Nice To Haves

• Advanced or specific training in Purchased/Preferred Care or Indian Health Services functions is preferred.
• Four (4) to six (6) years related experience is also preferred.

Responsibilities

• Adds, edits, and updates appropriate patient referral information in TRIHCI’s RPMS and Next Gen system.
• Monitors and guides the process of securing and delivering patient referrals for a variety internal and external specialty services, including optical, dental, medical, hospital, hospice, home health, radiology, DME and/or other services.
• Coordinates the compilation, flow, and maintenance of information relating to patient referrals, including verification of patient eligibility, patient benefits, alternative resources identification and utilization, contract and network provider status, and other documentation (e.g. radiology reports, labs and tracking of DME supplies, ie hospital beds, wheelchairs and incontinent supplies, etc.).
• Responds to, assists, and manages patient inquiries regarding their initial or follow-up appointments, referral requests, purchase orders, transportation options, PRC or IHS regulations, or other related issues in a courteous and professional manner.
• Maintains strong relationships with the professional medical community and updates information relating to Health Plans or payers regarding referral requests and patient options.
• Works collaboratively with clinic staff, Patient Services Representative, and our Patient Benefits Coordinator to ensure appropriate referrals are being made, registration is current and up to date and alternative resources are being explored in accordance with PRC guidelines.
• Receives and processes bills and/or purchase orders for payment, Claims are repriced through a website to automate the PRC Rate with proper fiscal procedures, including elements of proper coding and RPMS entry and maintains appropriate logs for claims tracking.
• Serves as an internal and external resource for all issues relating to PRC processes, referrals, insurance information, purchase orders and related information at TRIHCI.
• Reviews and submits outgoing letters, faxes, memos, and/or other correspondence as needed to support the provision of effective patient care.
• Serves as a primary representative of the PRC department at assigned clinic and community outreach activities.
• Participates in the TMAA claiming process.
• Participates in all required staff meetings and trainings.
• Performs all other duties as assigned.

Benefits

• TRIHCI maintains a drug- and alcohol-free workplace, and all offers of employment are contingent on the successful completion of a criminal background check, a post-offer drug test and physical, and TB test, and verification of each candidate’s right to work in the United States.
• Preference in hiring is given to qualified American Indians in accordance with the Indian Preference Act (Title 25, U.S. Code, § 472 & 473). Applicants claiming Indian Preference must submit Indian verification, certified by Tribe of affiliation or other acceptable documentation of Indian heritage.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED