PURCHASED REFERRED CARE CLERK

Fort Defiance Indian Hospital Board, Inc.•Fort Defiance Agency, AZ

2d•$15 - $18

About The Position

Initiates Purchased/Referred Care (PRC) applications from external providers by obtaining information from patient family members, or designated responsible person. Initiates PRC applications for FDIHB medical staff, nursing, and ancillary staff. Updates the patient’s registration database, including but not limited to income information, third party information, and any other information required to meet the eligibility factors of the PRC Program. Logs in all PRC applications/notifications by date of service. Routes all PRC applications/notifications to Chief Medical Officer (CMO) for medical priority. Provides education to patients and providers on the PRC five (5) eligibility factors. Issues purchase orders (PO) and/or denials are within specified time limits. Follows up with vendor for payment inquiry discrepancies, open documents and provides status on all PO's. Maintains PRC files according to current filing system. Assists with submitting and closing out Catastrophic Health Emergent Funds (CHEF) cases to assure reimbursement. Assists with Emergent transport requests from inpatient/outpatient departments by contacting ground and/or air medical transportation. Assists with received information for emergent transport companies and share information with receiving facility. Assists patients and providers with arranging non-emergent transports. Maintains transportation log for all medical transports. Provides information by telephone and personal inquiries regarding payment, outstanding charges eligibility, etc. Gathers information that are sensitive to PRC cases for eligibility, denials, appeals to submit to appropriate department. Enters all patient referrals into Referral Care Information System (RCIS) and ensures approval or denial is issued to patients and/or vendors. Performs other duties as assigned.

Requirements

One (1) year experience in registration, scheduling, screening, or customer service.
High School Diploma or Equivalency (HSE).
APPLICANT MUST HAVE A VALID, UNRESTRICTED INSURABLE DRIVERS LICENSE

Responsibilities

Initiates Purchased/Referred Care (PRC) applications from external providers by obtaining information from patient family members, or designated responsible person.
Initiates PRC applications for FDIHB medical staff, nursing, and ancillary staff.
Updates the patient’s registration database, including but not limited to income information, third party information, and any other information required to meet the eligibility factors of the PRC Program.
Logs in all PRC applications/notifications by date of service.
Routes all PRC applications/notifications to Chief Medical Officer (CMO) for medical priority.
Provides education to patients and providers on the PRC five (5) eligibility factors.
Issues purchase orders (PO) and/or denials are within specified time limits.
Follows up with vendor for payment inquiry discrepancies, open documents and provides status on all PO's.
Maintains PRC files according to current filing system.
Assists with submitting and closing out Catastrophic Health Emergent Funds (CHEF) cases to assure reimbursement.
Assists with Emergent transport requests from inpatient/outpatient departments by contacting ground and/or air medical transportation.
Assists with received information for emergent transport companies and share information with receiving facility.
Assists patients and providers with arranging non-emergent transports.
Maintains transportation log for all medical transports.
Provides information by telephone and personal inquiries regarding payment, outstanding charges eligibility, etc.
Gathers information that are sensitive to PRC cases for eligibility, denials, appeals to submit to appropriate department.
Enters all patient referrals into Referral Care Information System (RCIS) and ensures approval or denial is issued to patients and/or vendors.
Performs other duties as assigned.