Purchased Referred Care (PRC) Eligibility Technician

Kenaitze Indian Tribe • Kenai, AK

7d

About The Position

The Purchased Referred Care (PRC) Eligibility Technician is responsible for reviewing referrals from Health Systems Departments that are placed to external non-Indian Health Services (IHS) facilities that may qualify for Purchase Referred Care (PRC) funding. The Technician is required to adhere to the Purchase Referred Care Policy and Procedure throughout the process. The PRC Eligibility Technician will walk un'ina (patients) through the Purchase Referred Care Process as lined out in the policy and procedure. The PRC Eligibility Technician will coordinate with the supervisor to ensure all documentation is provided to the Purchase Referred Care Workgroup and to communicate if any additional information is needed from the Health Systems Departments.

Requirements

• High School Diploma or General Education Degree (GED)
• One (1) year of experience in a medical office
• One (1) year of experience with Purchase Referred Care
• One (1) year experience customer service
• Proficiency with Microsoft Suite, or obtain training within 90 days of hire
• Ability to multi-task, work independently, and meet deadlines
• Detail oriented, Interpersonal skills, problem-solving skills and technical skills
• Conducts business in a service-oriented manner that is attentive, pleasant, respectful and kind when dealing with un'ina, visitors, co-workers and others
• Knowledge of Health Insurance Portability and Accountability Act (HIPAA)
• This position is a Covered Position subject to all requirements of the Alaska Barrier Crimes Act (ABCA) and to the Indian Child Protection and Family Violence Prevention Act, (ICPA). ABCA and ICPA requirements apply and must be complied with at all times in order to remain in the position.
• Memorandum of Understanding: Serves as documented evidence that the Kenaitze Indian Tribe has expressed the ineligibility of an employee to operate motor vehicles owned, leased or rented by the Kenaitze Indian Tribe, or to operate a personal vehicle on behalf of the Kenaitze Indian Tribe.

Nice To Haves

• Knowledge and experience working with cultural diversities

Responsibilities

• Reviews all referrals from the Health Systems Departments to external non-Indian Health Services (IHS) facilities to ensure each referral meets the required eligibility requirements of the Purchase Referred Care Policy and Procedure
• Assists the supervisor in reviewing urgent care and emergency department claims submitted by un'ina to ensure compliance with non-clinical eligibility requirements for the PRC program participates in Purchase Referred Care Workgroup to present referral eligibility and provides timely follow up to un'ina regarding the workgroup's eligibility decision
• Accurately documents all un'ina communication in the un'ina electronic health record (EHR) and case management system
• Provides clear communication with un'ina, family members, and Kenaitze Indian Tribe staff on the PRC process
• Reconcile and process vendor invoices (ANTHC, Quest, City of Kenai, North Star Medical Imaging, Kenai Peninsula Borough, Procare, etc.)
• Assist the supervisor in presenting all appeals to the PRC Workgroup, providing clarification to the PRC appeal process to un'ina and coordinating the accurate processing and distribution of PRC approval or denial letters to un'ina following decisions by the PRC Workgroup or the PRC Appeal Workgroup's decision
• Completes the PRC referral process by working closely with the Travel and Referral Technicians and Un'ina Navigators
• Ensures compliance with Tribal, federal, state, and local employment laws and regulations, Tribal policies and TERO ordinance

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 101-250 employees