Purchase Referred Care Clerk

Position Summary:

Under direct supervision of TRIHCI’s Purchased Referred Care (PRC) Officer, the PRC Clerk provides support services to the PRC Officer, PRC Resource and Records Coordinator(s) in maintaining a viable Purchased Referred Care program which operates in compliance with all regulatory requirements.

Essential Duties and Responsibilities:

• Oversee bill log and assign bills to PRC Resource Coordinator
• Review referrals for eligibility and prepare for the Referral Review Committee
• Oversees Referral Log and assign referrals to the PRC Resource Coordinator
• Correspond by mail and informs patients of authorized referrals and their Purchased/Referred Care (PRC) status.
• Assist patient services representatives with required documents for Purchased/Referred Care eligible patients.
• Work collaboratively with outside providers and informs of Alternate Resource information and/or if the Insurance/ Alternate Resource has yet to be billed.
• Respond and assist patient on appointment dates and serve as a liaison between patient and the specialty provider.
• This position will have EHR Patient Registration view access.
• Directly communicates or coordinates with the PRC Resource Coordinator of patient’s continuous appointment dates and time, vendors name and address
• Communicate with patients of referral process, informing the PRC Resource Coordinator if there is recommendation of another specialty referral, labs, x-rays and or hospitalization.
• Coordinate with patient the payment process and the collection of the EOB.
• Communicate with the patient and the finance department on the process of requested PO’s to be paid and status of payment.
• Communicates and informs patient and vendors of payment status and date.
• Participate in staff meetings.
• Performs other duties as assigned.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed here are representative of the knowledge, skills, and/ or abilities required. In accordance with the American with Disabilities Act (ADA), reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Possess a Valid California Driver’s License and be insurable with the Tule River Indian Health Center Inc. insurance agency.
• Must pass pre-employment drug & alcohol test.
• Must pass pre-employment physical.
• Must pass background check.
• Must maintain a professional appearance and attitude.
• Must be punctual and reliable;
• Must maintain absolute confidentiality regarding patients per HIPAA and TRIHCI policies.
• Must be able to multitask, prioritize and handle many incoming calls or patients at once.
• Must demonstrate the ability to maintain accurate records and prepare clear and accurate reports for informational, auditing, and operational use, including capacities for attention to detail and for reviewing and verifying accuracy of data.
• Experience working in a health care facility setting.
• Possess experience in scheduling patients according to availability.
• Must possess good communication skills, be able to effectively communicate with diverse populations, and be willing to convey responsibilities to patients.
• American Indian preference in accordance with Indian Preference Act (Title 25, U.S. Code, § 472 & 473).

Knowledge, Skills, and Abilities

• Knowledge of the Purchased Referred Care Applications/Notification, Eligibility, Denial/Approval and Appeal process, and other related health insurance processes or managed care programs.
• Knowledge of the Health Insurance Portability and Accountability Act (HIPAA) regarding patient confidentiality of all medical records and Contract Health patient individual files.
• Knowledge of Medicare/Medicaid, AHCCCS, Social Security Administration, County, State and Tribal health programs.
• Knowledge of the Purchased Referred Care program and activities including an awareness and understanding of the purpose, objectives, commitments and priorities to perform both recurring and special assignment.
• Working knowledge of various third parties, such as Medicare, Medicaid, Private Insurance, etc., availability of health care resources, rules of eligibility for medical and other available programs to assist in payment of health care costs.
• Knowledge of medical terminology and medical care practice and procedures.
• Skill in operating a computer-automated PRC/CHS system data entry; retrieval of purchase orders and denial letters, as well as word processing.
• Skill in the utilization of computer print-outs, fiscal and health care data; as well as excellent and efficient keyboard skills.
• Skill in establishing and maintaining effective working relationships with patients, providers, staff and general public.
• Excellent proficiency in computer software and applications associated with a business environment including Microsoft Office (Excel, Outlook, PowerPoint, and Word).
• Ability to gather information from face-to-face interview or by telephone with patients and private contractors.
• Ability to communicate effectively both orally and in writing.
• Ability to maintain the confidentiality of patient information.

Education and/ or Experience

1. High school diploma or general education degree (GED); or

2. Two (2) years or more related experience and/or training, or

3. Equivalent combination of education and experience;

4. One (1) year of prior experience in a health care setting is also required;

5. Familiar with entering data into an electronic healthcare database system.

Certificates, Licenses, Registrations

• Possess a current, valid California driver’s license, driving insurance and a good driving record are required for this position.
• Possess First aid/ CPR at the BCLS level are required or obtained within three (3) months of hire.

Contingencies

TRIHCI maintains a drug and alcohol-free workplace, and all offers of employment are contingent on the successful completion of a criminal background check, a post-offer drug test and physical, and verification of each candidates right to work in the United States.

Physical Work Environment: the description provided here is representative of those conditions in which the PRC Clerk will be required to perform the essential function of this position. As stated earlier, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

While performing the duties of this position, the PRC Clerk is situated in a standard office environment within the health center, where there is little or no exposure to variations in the either or other similar elements. The PRC Clerk will primarily be stationed in the Purchased Referred Care (PRC) building but will also move about the health center to meet with physicians, patients, and co-workers. Consequently, the PRC Clerk must:

• Possess the mobility to work in a standard office setting (i.e. walk, stand, or sit for extended periods of time);
• Posses the ability to use standard office equipment to write, type, copy, fax, or perform other duties;
• Possess the strength to lift and carry supplies weighing up to 10 lb. repeatedly and up to 30 lb. intermittently;
• Possess the visual acuity to read printed material and a computer screen; and
• Demonstrate hearing and speech capabilities that allow him/her to communicate in person and over the telephone as required.

The clinical setting at TRIHCI is categorized by OSHA and a Blood-Borne Pathogen Category I facility. Thus, there may exist the potential for exposure to blood, body fluid/tissue, and infectious wastes. There also exists the potential for exposure to chemicals, biological, toxicants, and irradiates found on-site.

Disclaimer:

The position description lists the major duties and requirements for the PRC Clerk position as established by subject-matter experts and the Human Resources Manager at the time of this document’s creation. This position may require additional performance of duties and responsibilities beyond those outlined in this document, and thus may require additional sets of knowledge, skills and abilities not fully articulated herein.

Job Type: Full-time

Pay: $15.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift

Ability to commute/relocate:

• Porterville, CA 93257: Reliably commute or planning to relocate before starting work (Required)

Education:

• High school or equivalent (Preferred)

Experience:

• Customer service: 1 year (Preferred)

Work Location: One location