Purchased Referred Care Specialist

Tuba City Regional Health Care Corporation•Tuba City, AZ

10d•Onsite

About The Position

This position is responsible for initiating the Purchased Referred Care (PRC) application intake process by obtaining information from patients, family members, provider staff within TCRHCC service area, Professional and non-professional staff from outside private providers. The Specialist is responsible for updating and maintaining the patient registration database such as income information, third party payer information and any other information required to have patient meet the five eligibility factors of the PRC program.

Requirements

Must have a High School Diploma or GED
Must have one-year general clerical experience that includes data entry and providing customer service.
A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas:
Positive working relationships with others – fosters teamwork
Possession of high ethical standards and no history of complaints
Reliable and dependable; reports to work as scheduled without excessive absences.
Effective communication skills to deal effectively with all levels of co-workers.
Ability to multi-task, prioritize and manage time to strict deadlines.
Must be proficient with typing and accurate spelling/grammar.
Complete Patient Sitter Competency Training (upon hire)
Completion of an above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job.
Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job.
Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job.
Submission of all required employment-related documents, application, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC.

Responsibilities

Welcomes & greets patients/visitors in person and/or the telephone; answers or refers inquiries; directs patients/visitors; documents calls and visits; records and delivers messages to appropriate personnel. Politely communicates with respect to patients and families during time of emotional, mental, and physical stress.
Receives, stamp dates daily patient referrals/notifications from patients, TCRHCC providers, and/or other facilities. Reviews referrals against TCRHCC electronic medical records to determine if patient meet PRC eligibility criteria ensuring applicable processes, making independent decisions confidently, and must be able to support decisions and/or purpose of actions taken.
Distribute referrals to appropriate outside provider for scheduling of appointments, then follows up on referrals to obtain appointment date and time. Mails referral and PRC letter to patient with their appointment date and time. Forwards referrals for non-TCRHCC patients to appropriate service unit within 72 hours of receipt.
Identifies notifications and attaches appropriate cover sheet including any supporting documentation i.e., TCRHCC patient face sheet, Arizona Health Care Cost Containment System (AHCCCS) verification forms, obtains/copies of any other alternate resources, claims, medical notes, etc. Compiles corresponding documents and inputs pertinent data into system to establish record and obtain a referral.
Researches the electronic health record (EHR) to identify existing medical records for patient and date of service (DOS) per notification to prevent duplication of records. Notes case number on notifications and other documents for quick referencing and forwards to Caseworkers for processing.
Responsible for daily data entry of referrals/notifications into the PRC management software; establishing patient records and processing claims.
Educates patients/clients about PRC scheduling process, and obtains necessary documents such as PCC visit notes, lab report and radiology report. Explains PRC rules and regulations, eligibility, policy/procedures. Conducts reviews on a periodic basis to ensure proper and timely follow-up.
Interviews patients and/or family members to determine potential eligibility for any alternate resources and makes the necessary contacts with the identified resources. Enters notes and actions taken for each record, i.e., phone calls, providers, purposes, etc.
Administers the day-to-day activities required of the PRC program by initiating PRC medical purchase orders. Assures the issuance of purchase order(s) to providers is within specified time limits. Maintains files of all correspondence for future confirmation and/or referencing. Provides information to HIM of patient’s name and name of receiving facility for accidental injuries and Tort Claims.
Maintains professional skills by attending in-services, workshops and participates in continuing education.
Ensure proper PPE is always worn while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, and eye or face shield as required.
Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updates).
Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a prominent level of patient, visitor, employee, and external customer satisfaction.
Performs other duties as assigned.