Purchased Referred Care Clerk

Tule River Indian Health Center Inc•Porterville, CA

4h•$15 - $21•Hybrid

About The Position

Under direct supervision of TRIHCI’s Purchased Referred Care (PRC) Officer, the PRC Clerk provides support services to the PRC Officer, PRC Resource and Records Coordinator(s) in maintaining a viable Purchased Referred Care program which operates in compliance with all regulatory requirements. 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

Must pass pre-employment drug & alcohol test.
Must pass pre-employment physical.
Must pass background check.
Must maintain a professional appearance and attitude.
Must be punctual and reliable.
Must maintain absolute confidentiality regarding patients per HIPAA and TRIHCI policies.
Must be able to multitask, prioritize and handle many incoming calls or patients at once.
Must demonstrate the ability to maintain accurate records and prepare clear and accurate reports for informational, auditing, and operational use, including capacities for attention to detail and for reviewing and verifying accuracy of data.
Experience working in a health care facility setting.
Possess experience in scheduling patients according to availability.
Must possess good communication skills, be able to effectively communicate with diverse populations, and be willing to convey responsibilities to patients.
American Indian preference in accordance with Indian Preference Act (Title 25, U.S. Code, § 472 & 473).
Knowledge of the Purchased Referred Care Applications/Notification, Eligibility, Denial/Approval and Appeal process, and other related health insurance processes or managed care programs.
Knowledge of the Health Insurance Portability and Accountability Act (HIPAA) regarding patient confidentiality of all medical records and Contract Health patient individual files.
Knowledge of Medicare/Medicaid, AHCCCS, Social Security Administration, County, State and Tribal health programs.
Knowledge of the Purchased Referred Care program and activities including an awareness and understanding of the purpose, objectives, commitments and priorities to perform both recurring and special assignment.
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.
Knowledge of medical terminology and medical care practice and procedures.
Skill in operating a computer-automated PRC/CHS system data entry; retrieval of purchase orders and denial letters, as well as word processing.
Skill in the utilization of computer printouts, fiscal and health care data; as well as excellent and efficient keyboard skills.
Skill in establishing and maintaining effective working relationships with patients, providers, staff and general public.
Excellent proficiency in computer software and applications associated with a business environment including Microsoft Office (Excel, Outlook, PowerPoint, and Word).
Ability to gather information from face-to-face interview or by telephone with patients and private contractors.
Ability to communicate effectively both orally and in writing.
Ability to maintain confidentiality of patient information.
Possess First aid/ CPR at the BCLS level are required or obtained within three (3) months of hire.

Responsibilities

Oversee bill log and assign bills to PRC Resource Coordinator.
Review referrals for eligibility and prepare for the Referral Review Committee meeting.
Oversee Referral Log and assign referrals to the PRC Resource Coordinator.
Correspond by mail and inform patients of authorized referrals and their Purchased/Referred Care (PRC) status.
Assist patient services representatives with required documents for Purchased/Referred Care eligible patients.
Work collaboratively with outside providers and informs of Alternate Resource information and/or if the alternate resource has yet to be billed.
Respond and assist patients on appointment dates and serve as a liaison between patient and the specialty provider.
This position will have EHR Patient Registration view access.
Directly communicates and coordinates with the PRC Resource Coordinator of patient’s continuous appointment dates and time, vendors name and address.
Communicate with patients of referral process, informing the PRC Resource Coordinator if there is recommendation of another specialty referral, labs, x-rays and hospitalization.
Communicates with patient the payment process and the collection of the EOB.
Review bill log and follow up on requested documents needed to process bills for payment.
Communicate with the patient and the finance department on the process of requested PO’s to be paid and status of payment.
Communicates and informs patients and vendors of payment status and date.
Oversee and generates the PRC identification card.
Participate in staff meetings.
Performs other duties as assigned.