Purchased Referred Care Supervisor

Salt River Pima-Maricopa Indian Community•Scottsdale, AZ

9d•Onsite

About The Position

Under general administrative program supervision of the Purchased Referred Care Manager, this position oversees the daily operations and supervises the Referral Coordinators of the Salt River Purchased Referred Care Department. This includes coordination and monitoring of all PRC referrals, serving as an advisor on the PRC program regarding policy implementation and interpretation, program planning, program development, administration, management, operation, and evaluation of a comprehensive PRC program. This job class is treated as FLSA-Exempt.

Requirements

High school diploma or GED required.
Minimum of 3 years’ full-time work experience managing and leading staff.
2 years’ experience (minimum) with employee performance management (e.g., evaluations, technical assistance, corrective action, etc.).
Knowledge of the culture, customs, traditions, history and government of the Salt River Pima- Maricopa Indian Community.
Knowledge of the federal Freedom of Information Act, Privacy Act and HIPAA laws as they pertain to the SRPMIC work environment.
Knowledge of PRC programs and regulations.
Knowledge of RPMS packages: RCIS, CHSMIS, EHR, Patient Registration and BCBS Fiscal Intermediary (FI).
Knowledge of AHCCS online, Novitas online and other insurance eligibility online eligibility systems.
Knowledge of various clinical systems, walk-ins and appointments to avoid unnecessary delay and/or confusion on the part of patient.
Knowledge of various medical services offered by the clinic.
Knowledge of patient business functions and processes to augment Third Party Billing activities and routines.
Knowledge of CPT, ICD-10, HCPCS and dental coding and billing activities.
Ability to understand and comply with the requirements of the Privacy Act, HIPAA, and maintaining confidentiality of patient information.
Knowledge of alternate resources: State Medicaid (AHCCCS), Medicare, Medicare Advantage Plans, Private insurance, Tribal Self-Insured insurance plans and other related programs.
Knowledge of administrative/clerical procedures and systems (e.g. equipment, file management, software programs, etc.).
Ability to manage employees in a high-stress environment.
Ability to use excellent communication skills, both verbally and in writing, to deal effectively with all levels of co-workers.
Possession of high ethical standards.
Ability to work independently, multi-task, prioritize and manage time to strict deadlines.
Reliable and dependable; adheres to work schedule and SRPMIC attendance policies.
Knowledge of medical terminology and medical care practices and procedures.
Knowledge of CPT, ICD-10 and HCPCS coding.
Must be able to work beyond normal work hours including nights, weekends and holidays.
Must comply with the “Community Code of Ordinances”, Chapter 11, “Minors”, Article X. “Investigation of Persons Working With Children” if providing direct services to children.
Ensures all patient information is kept confidential and complies with Health Insurance Portability and Accountability Act (HIPAA) regulations and SRPMIC HHS policies and procedures.
Applicants will be subject to drug and alcohol testing prior to hire.
Will be required to pass a pre-employment background/fingerprint check.

Nice To Haves

4-year college degree preferred.
Experience working with health records, patient referrals, and scheduling preferred.

Responsibilities

Direct supervision of PRC Referral Coordinators, including training and guidance in the maintenance/safekeeping of patient medical referrals while maintaining security, confidentiality, accuracy, completeness, and accessibility of health information.
Schedules and supervises the work of assigned staff to achieve defined business goals and ensure smooth workflow in the department.
Coordinates team activities and staff to workload ratios for effective resource utilization.
Sets work goals for team members and monitors measurable outcomes in accuracy, timeliness, productivity, and service quality.
Provides leadership, work goals, and coaching for staff.
Participates in selecting hires and trains staff for assigned duties.
Develops and promotes strong inter-departmental teamwork to meet patient and provider needs, driving decision-making and other actions.
Provides training and guidance to new PRC staff members on the PRC workflow.
Conducts performance reviews, coaching/disciplinary action, and termination of assigned staff following the Community’s personnel policies.
Uses advanced business and software skills for creating documents, letters, spreadsheets, reports, and presentations.
Identifies training needs and provides or arranges for needed training.
Approves leave requests, provides advice, counsel, or instructions to employees on work and administrative matters.
Identifies and implements changes regarding policy, productivity, and quality measures, ensuring staff performance improvements related to work-flow efficiencies and operations.
Provides support and technical assistance to the PRC Referral Coordinators on matters involving referrals for medical, surgical, dental, hospital, and clinical services to all eligible beneficiaries.
Performs liaison functions with contract health providers, state and local agencies; and monitors/reports status of PRC activities and funds.
Establishes community and payor relationships while maintaining compliance with payment and financial analysis to ensure effective department functions.
Prepares analytical data, staff reports, and memoranda reflecting utilization of PRC funding resources.
Maintains up-to-date knowledge on regulatory changes for effective management of the health record system and PRC program and guidelines.
Develops, recommends, and implements changes to PRC policies, procedures, and Standard Operating Procedures (SOP).
Demonstrates Customer Service/Conflict Resolution Experience.
Performs other duties as assigned.
Prepares monthly statistical reports on data quality, individual PRC Referral Coordinator assigned patient referrals, and assures the issuance of Purchase Orders/claim payments to providers are within specified time limits.
Ensures PRC Referral Coordinators adhere to knowledge of alternate resources (state Medicaid, Medicare, Medicare Advantage Plans, Private Insurances, Tribal Health Insurance).
Screens all cases for PRC eligibility.
Ensures all eligibility factors are met prior to obligating PRC funds.
Refers patients to Benefit Coordinators to apply for alternate resources when potentially eligible and documents efforts.
Performs other related duties as assigned.