Patient Referred Care Technician - Temporary

Job Details: Education Level: High School, Salary Range: Undisclosed, ESSENTIAL DUTIES, FUNCTIONS AND RESPONSIBILITIES Determines patient eligibility for Purchased Referred Care. Conducts on-site patient interviews to establish eligibility and completes and maintains application for medical care. Verifies records of residence for applications by addressing inquiries to a variety of sources.

Maintains sufficient records, authorizations or clinic information, eligibility forms and standard forms. Initiates medical authorizations to include hospitalization and professional fees for eligible patients; maintains denial correspondence files assuring that all appropriate documentation is included in file. Processes procurement orders for requested contract health services.

Assures funds have been obligated within deadlines and unused obligations are cancelled; making sure transactions affecting funds are promptly processed. Obligates funds in automated data system (RPMS). Assists with the reporting of Catastrophic Health Emergency Fund (CHEF) cases by obligating these funds as soon as possible.

Keys data into the CHS/MIS data system for issuing purchase orders. Maintains obligation and expense records regarding PRC funds for inpatient and outpatient services. Defines alternate resources available to patients; determines patient eligibility for resources; helps patients with alternate resources compliance. Contacts state agencies and other outside organizations to determine medical eligibility.

Cross compares proposed authorizations with sources prior to obligating funds for contract health services. Creates, maintains and reviews correspondence related to PRC authorizations for payment or non-payment. Inputs daily into the RPMS, PRC data notifications information, referral information, patient registration, PRC denial information and any other appropriate PRC program data necessary to meet established mandatory guidelines and deadlines.

Reviews incoming invoices to determine if authorizations have been issued and if not, researches and takes appropriate action. Assures appropriate use of CHS services, verification of claims, utilization and review of available services, examination of unpaid bills to assure the maximum utilization of all potential and available third-party reimbursement resources.

Provides technical support assistance regarding the patients accounts of bills submitted for payment by providers and provides support for improving the rate, promptness and amount of payment. Track allocation of PRC funds to assure the program stays within budget; assures effective and maximum, utilization of PRC funds; provides the supervisor informal reports on fund status expenditures on a periodic basis.

Coordinates activities associated with PRC; coordinates referral services and payment efforts with clinic and business office staff; communicates with vendors, contractors and third parties. Responds to inquiries and requests through telephone, correspondence and personal visits. Identifies errors in data and take corrective action.

Provides PRC orientation to health services vendors, and recipients, as well as CBN Health Center staff to insure they have a good understanding of the program methods, policies, procedures and regulations; assist healthcare and other professional staff members in understanding elements and requirements of the PRC program.

Supports Patient Registration, Medical Records and Patient Benefits. Answers telephone and written inquiries regarding eligibility requirements, payments, outstanding charges, and other questions concerning the PRC program; maintains strict confidentiality in responding to inquiries. Performs other duties as assigned.

: MINIMUM MANDATORY QUALIFICATIONS Experience Two (2) years of similar or related experience in a healthcare setting.

Education

High School Diploma Mandatory Knowledge, Skills, Abilities and Other Qualifications Must be able to carry out the essential duties, functions and responsibilities. Knowledge of applicable federal, state, county and local laws, regulations and requirements. Knowledge of medical insurance claims procedures and documentation.

Knowledge of the precertification requirements, procedures and documentation of third-party medical insurance payors. Ability to gather data, compile information, and prepare and maintain written records and reports. Strong working knowledge of computers and software applications. Knowledge of Medicaid, Medicare, Social Security, Tribal, and Department of Human Services and private health insurance.

Knowledge of a body of standardized rules, procedures, or operation that require considerable training and experience to perform the full range for a Patient Benefits Advocate and resolve recurring problems. Excellent knowledge of a healthcare setting. A team player with excellent communication and interpersonal skills.

Ability to communicate clearly and effectively with patients and other external parties in a courteous and friendly manner at all times. Must be able to maintain confidentiality at all times. Ability to perform other duties as assigned.

PREFERRED QUALIFICATIONS

Bilingual skills in English and the Navajo language. Bachelor’s degree in Business Administration. Three to five years of clinical setting or equivalent experience as a Patients Benefits Coordinator.