Purchased Referred Care (PRC) Coordinator Trainee

Purchased Referred Care (PRC) Coordinator Trainee

Department:   
Health Services

Reports to:  
Health Clinic Office Manager

FLSA Status:  
Non Exempt

TS Range:  
5/6 (6/7 after successful training year)

Approved By:
L. Bonnie Sanchez

Opening Date: 
February 17, 20117

Closing Date:  
March 3, 2017

SUMMARY:
Coordinates and maintains all aspects of the Purchased Referred Care (PRC) program which provides for medical care outside the Health Clinic.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
Other duties may be assigned.

Generates and processes purchase orders, payments, and denials for specialty care services at doctor’s offices, clinics and hospitals. Daily data entry requirements to update and maintain RPMS computer database records.

Researches billing and payment histories. Contacts insurance companies, billing departments, and lab offices to determine allowable charges, existing payments and balance due. Persistence and patience required to maintain on-going and repeated research on old out-standing purchase orders.

Prepares check requests and back-up documentation for Tribal accounting department to process payments.

Maintains thorough and accurate program records and patient charts including frequent computer information updating and ongoing, consistent chart filing.

Accurately maintains petty cash fund to reimburse co-payments and replenish fund as needed.

Ensures and maintains strict confidentiality with regard to all aspects of job duties as well as knowledge from associated programs in the department.

Fairly and consistently follows guidelines to determine appropriateness to issue purchase order or denial for services.

Assists and/or refers to alternate funding resources in order to maintain PRC as a payer of last resort.

Monitors expenditures and prepares reports as requested by Health Clinic Administration.

Provides community outreach, awareness and educational services related to PRC.

COMPETENCY:
To perform the job successfully, an individual must be able to manage difficult or emotional patient situations, listen to others without interrupting, keep emotions under control, inspire trust in others, work with integrity and ethics, exhibit sound and accurate judgment, include appropriate people in decision-making process, and treat others with respect and consideration regardless of their status or position.

QUALIFICATIONS:
To perform this job successfully, in individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION AND/OR EXPERIENCE
Associates Degree and one year of related business or health related program experience OR High School Diploma or GED and three of related business or health related program experience.

Willingness to develop skills in MS Word, Excel and RPMS Software required.
Strong organizational, writing and math skills required.

Skills assessment testing will be part of the interview process. (Basic writing and math).

Must also have work experience demonstrating the ability to:

Respond professionally, in person and on the phone, to patients and medical providers in tense and occasionally hostile situations.
Maintain strict confidentiality in small community environment.
Complete work independently and in a team environment.

SUPERVISORY RESPONSIBILITIES:
This position has no supervisory responsibilities.

LANGUAGE SKILLS:
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers and the general public.

MATHEMATICAL SKILLS:
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations.
 
REASONING ABILITIES:
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
 
CERTIFICATES, LICENSES, REGISTRATIONS: 
Employee must be bondable.

PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is occasionally required to stand, walk, climb or balance, stoop, kneel or crawl, taste or smell. The employee is frequently required to sit, use hands to finger, handle or feel, reach with hands and arms, and talk or hear. The employee must occasionally lift up to 50 pounds and frequently lift up to 10 pounds. Specific vision abilities required by this job include close vision, i.e. clear vision at 20 inches or less.

WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee may occasionally work near moving mechanical parts. The noise level in the work environment is usually moderate.

DRUG FREE WORK PLACE:
The successful candidate will be required to have a urinalysis for drug and alcohol screening, in accordance with the Tribe’s Drug Free Workplace policy and can have no history of illicit or prescription drug abuse.

INDIAN PREFERENCE:
Indian Preference will be exercised in the hiring of this position consistent with the Tribe’s Personnel Policies.

CONTACT:
Human Resources Department (360) 426-9781