Purchased Referred Care Technician in Arcata CLOSES 8/20

United Indian Health Se•Arcata, CA

7d•$24 - $31•Onsite

About The Position

This position is 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. The role involves maintaining PRC files, determining eligibility, communicating with providers and agencies, and tracking cases through payment processing. The technician will also prepare reports, attend meetings, and must demonstrate a commitment to cultural sensitivity and awareness when working with American Indian/Alaska Native people.

Requirements

High school diploma or general education diploma (GED)
0-1 years of clerical office or related experience (for Level I)
1-2 years of experience working with PRC or other related areas (for Level II)
3 or more years of experience in PRC or related areas (for Level III)
Ability to use or be trained on the use of the various computer software systems used by the organization.
Intermediate personal computer skills, including electronic mail, routine database activity, word processing, spreadsheet, graphics, etc.
Able to learn and work with the electronic health record and practice management systems.
Ability to work independently and as part of a team (for Level II and III).
Demonstrate a commitment to the provision of culturally sensitive counseling services to American Indians.

Nice To Haves

Experience in a health care setting preferred (for Level II)
Experience in health care setting required (for Level III)
Able to train level I (for Level II)
Able to train level I or II (for Level III)

Responsibilities

Maintains PRC files accurately.
Determines if incoming PRC referrals and emergency care notices are within the UIHS approved priorities.
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.
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/guidelines.
Other duties may be assigned.