Purchased/Referred Care (PRC) Specialist

Tuba City Regional Health Care Corporation•Tuba City, AZ

About The Position

The Purchased/Referred Care (PRC) Specialist initiates the PRC application intake process by collecting information from patients, family members, TCRHCC providers and staff, and staff at outside providers. The Specialist updates and maintains patient registration records, including income and third-party payer information, to support evaluation of the five PRC eligibility factors. The role welcomes and assists patients and visitors, processes referrals and notifications, researches electronic health records, enters information into PRC management software, coordinates appointments and follow-up, and helps patients understand PRC eligibility, policies, and procedures. It also supports day-to-day program administration, maintains records and correspondence, follows required infection prevention procedures, and performs other duties as assigned.

Requirements

High school diploma or GED.
One year of general clerical experience that includes data entry and customer service.
Satisfactory performance in prior and current employment, supported by positive employment references.
Ability to foster teamwork and maintain positive working relationships.
High ethical standards and no history of complaints.
Reliability and dependability, including reporting to work as scheduled without excessive absences.
Effective communication skills for working with all levels of coworkers.
Ability to multitask, prioritize, and manage time to strict deadlines.
Proficiency in typing and accurate spelling and grammar.
Complete Patient Sitter Competency Training upon hire.
Above-satisfactory interview scores demonstrating ability to perform the essential functions of the job.
Successful background and reference checks, including positive employment references from authorized representatives of past and current employers.
Successful fingerprint clearance, physical examinations, and other required screenings.
Submit all required employment documents and information without false, misleading, or incomplete information.
Ability to meet the stated physical and mental demands of the role, with reasonable accommodation subject to review and approval.

Responsibilities

Welcome and greet patients and visitors in person and by telephone; answer or refer inquiries, direct visitors, document calls and visits, and deliver messages to appropriate personnel.
Communicate respectfully with patients and families who may be experiencing emotional, mental, or physical stress.
Receive and date-stamp daily patient referrals and notifications from patients, TCRHCC providers, and other facilities; review them against electronic medical records for PRC eligibility and make and support decisions in accordance with applicable processes.
Send referrals to appropriate outside providers for appointment scheduling, follow up to obtain appointment details, and mail the referral and PRC letter to patients with their appointment date and time.
Forward referrals for non-TCRHCC patients to the appropriate service unit within 72 hours of receipt.
Identify notifications and attach appropriate cover sheets and supporting documentation, including patient face sheets, AHCCCS verification forms, alternate-resource information, claims, and medical notes.
Compile related documents, enter pertinent data into the system, and establish records and referrals.
Research the electronic health record for existing patient records and dates of service to prevent duplicate records; note case numbers on documents and forward them to Caseworkers for processing.
Enter referrals and notifications daily into PRC management software, establish patient records, and process claims.
Educate patients and clients about the PRC scheduling process and rules, eligibility, policies, and procedures; obtain necessary documents such as PCC visit notes, lab reports, and radiology reports; conduct periodic reviews for proper and timely follow-up.
Interview patients and family members to identify potential eligibility for alternate resources, contact identified resources, and document notes and actions taken for each record.
Administer day-to-day PRC program activities by initiating medical purchase orders and ensuring orders are issued to providers within specified time limits.
Maintain correspondence files for future confirmation and reference, and provide HIM with patient and receiving-facility information for accidental injuries and Tort Claims.
Maintain professional skills by attending in-services and workshops and participating in continuing education.
Wear required personal protective equipment while on duty, complete PPE donning and doffing safely, and discard used PPE appropriately.
Complete task training for routine cleaning and decontamination of surfaces contaminated by communicable disease.
Perform other duties as assigned.