Purchased Referred Care; PRC Eligibility Technician

Position Information

Purchased Referred Care (PRC) Eligibility Technician

Department:
Health Systems Management

Program:
Health Systems

Reports To:

Medical Social Worker Supervisor

Employment Status:
Full-Time

FLSA Status:
Non-Exempt

Schedule:

40 Hours/52 Weeks

Preference: TER0 Ordinance 2017-01, P.L. 93-638

The PRC Eligibility Technician is responsible for reviewing referrals from Health Systems Departments that are placed to external non-Indian Health Services (IHS) facilities that may qualify for Purchase Referred Care (PRC) funding. The Technician is required to adhere to the Purchase Referred Care Policy and Procedure throughout the process. The PRC Eligibility Technician will walk un ina (patients) through the Purchase Referred Care Process as lined out in the policy and procedure.

The PRC Eligibility Technician will coordinate with the supervisor to ensure all documentation is provided to the Purchase Referred Care Workgroup and to communicate if any additional information is needed from the Health Systems Departments.

• Reviews all referrals from the Health Systems Departments to external non-Indian Health Services (IHS) facilities to ensure each referral meets the required eligibility requirements of the Purchase Referred Care Policy and Procedure
• Assists the supervisor in reviewing urgent care and emergency department claims submitted by un ina to ensure compliance with non-clinical eligibility requirements for the PRC program participates in Purchase Referred Care Workgroup to present referral eligibility and provides timely follow up to un ina regarding the workgroup's eligibility decision
• Accurately documents all un ina communication in the un ina electronic health record (EHR) and case management system
• Provides clear communication with un ina, family members, and Kenaitze Indian Tribe staff on the PRC process
• Reconcile and process vendor invoices (ANTHC, Quest, City of Kenai, North Star Medical Imaging, Kenai Peninsula Borough, Procare, etc.)
• Assist the supervisor in presenting all appeals to the PRC Workgroup, providing clarification to the PRC appeal process to un ina and coordinating the accurate processing and distribution of PRC approval or denial letters to un ina following decisions by the PRC Workgroup or the PRC Appeal Workgroup's decision
• Completes the PRC referral process by working closely with the Travel and Referral Technicians and Un ina Navigators
• Ensures compliance with Tribal, federal, state, and local employment laws and regulations, Tribal policies and TERO ordinance

It is the intent of this job description to highlight the essential functions of the position; however, it is not an all-inclusive list. The incumbent may be called upon and required to follow or perform other duties and tasks requested by his/her supervisor, consistent with the purpose of the position, department and/or the Kenaitze Indian Tribe's objectives.

Lifting Requirements

• Sedentary work – Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

Physical Requirements

• Stand or Sit (Stationary position)
• Walk (Move, Traverse)
• Use hands/fingers to handle or feel (Operate, Activate, Use, Prepare, Inspect, Place, Detect, Position)
• Talk/hear (Communicate, Detect, Converse with, Discern, Convey, Express oneself, Exchange information)
• See (Detect, Determine, Perceive, Identify, Recognize, Judge, Observe, Inspect, Estimate, Assess)
• Repetitive Motion

OSHA Categories

• Category III - Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid

Equipment and Tools

Equipment used for job:
Printer, Copier, Scanner, Desktop

Travel

• Local
• In-State

Education

• High School Diploma or General Education Degree (GED)

Experience

• One (1) year of experience in a medical office
• One…