Purchased Referred Care Technician - Closes 3/3/26

United Indian Health Se•Arcata, CA

11d

About The Position

Position shall be responsible for initiating, tracking, and processing “payer of last resort” health insurance claims according to United Indian Health Services (UIHS) Purchased Referred Care (PRC) guidelines.

Requirements

Must have High school diploma or general education diploma (GED)
All individuals must demonstrate a commitment to the provision of culturally sensitive counseling services to American Indians.

Nice To Haves

Experience in a health care setting preferred.

Responsibilities

Maintains PRC files accurately.
Have the ability to use or be trained on the use of the various computer software systems used by the organization to perform all job duties.
Determines if incoming PRC referrals and emergency care notices are within the UIHS approved priorities. Asks for assistance from the PRC Supervisor when needed.
Prepares and follows up on all referrals including those that need medical and dental review at the Managed Care Committee.
Determines if clients meet PRC eligibility requirements, including referral to Alternate Resources for screening and application if eligible. Also requests a copy of approved tribal documentation if necessary for the PRC file.
Contacts outside providers to request an estimate of charges. Creates purchase orders for eligible approved referrals.
Communicates and corresponds with outside agencies, provider offices, and clients regarding approved, pending or denied referrals, claim status and other requirements.
Communicates and corresponds with UIHS providers to clarify PRC referrals.
Tracks PRC cases through the processes of: appointment, outcome, third party insurance eligibility determination, and final claims payment processing.
Communicates, tracks and submits purchase orders, or claims to Humboldt Independent Practice Association (IPA) for payment processing.
Prepares and submits Catastrophic Health Emergency Fund (CHEF) cases following guidelines from IHS. Notifies supervisor of possible pending CHEF cases so they can be reported to the Member Services Manager and Chief Financial Officer.
Prepares periodic reports on claims reviewed, pending, and processed to completion.
Runs monthly reports, exports, and other miscellaneous reports as needed.
Attends and participates in PRC related meetings at both Board and Administrative levels as needed.
Must be willing to learn more about the American Indian culture and attend at least one Cultural Presentation/Training per year.
Must be willing to work with American Indian/Alaska Native people and demonstrate cultural awareness and humility
Must be willing to deliver services in a culturally responsive manner.
Adheres to accreditation and compliance standards/guideline
Other duties may be assigned.