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Purchased/Referred Care Clerk
Location:
Norfolk, NE
Description:
Position: Purchased/Referred Care Clerk Position Number: 432 N Division: Health Department: Purchased/Referred Care Reports To: Purchased/Referred Care Director Location: Norfolk Exempt/Non-Exempt: Non-exempt Salary: Grade 6 ($32,552.00- $51,873.27) Classification: Full- time Summary: The Purchased/Referred Care Clerk provides technical, administrative and clerical support to the PRC program. The purpose of this position is to facilitate and expedite PRC referrals throughout the PHS Healthcare Delivery System by providing day-to-day management of referred care for PRC eligible users. Essential Responsibilities and Duties: Adhere to the PRC Policy & Procedures manual. Initiates Purchased/Referred Care (PRC) applications from members residing in the 15-County Service Delivery Area by obtaining information from patients, family members, and other relevant stakeholders; updates the patient's registration database, including but not limited to tribal membership, residency, income information, third party information, and any other information required to meet the eligibility factors of PRC Program. Provides patient education on the different alternate resources that are available to patients, assists with application process, and educates patients or providers on PRC eligibility factors. Refer to Patient Benefits Coordinators who can advocate for the patient in the search of and utilization of alternate resources. Works closely with other resources g. Medicare, Medicaid and private insurance etc. on identifying coverage for patients, check for prior-authorization requirements/determinations to maximize insurance benefits and networks. Communicates heavily with other departments/other ITUs, patients, nursing and other medical staff regarding program requirements to ensure quality coordination of patient care. Assists with negotiating provider Create and manage patient care files, requesting treatment plans, chart notes, diagnostic reports, x-rays and lab reports and submit to medical records for provider review. Routes PRC referrals to PRC Committee for medical necessity review and prioritization. Contact outside vendors to set up/verify appointments for approved cases, obtain estimate of charges, and notify patients/vendors on authorization status. Keys data into Aprima and RPMS data systems for issuing purchase orders for authorized services. Tracks PRC cases through the processes of: appointment, scheduling, outcome, third party insurance eligibility requirement determination, and final claims payment process. Have the ability to understand and interpret vendor invoices, statements, insurance EOBs and other requests for payment. Maintains accurate documentation regarding all information received and actions taken. Reviews incoming invoices to determine if authorizations have been issued and if not, research and takes appropriate action. Coordinate and generate denial notices, ensuring accurate data is entered and submitted to appropriate administrator for review and decision. Communicates and corresponds with patients/vendors by telephone, mail or personal inquiries regarding claims status. Identify, prepare and submit Catastrophic Health Emergency Fund (CHEF) cases following IHS guidelines to the appropriate administrator for review and decision. Participates in PRC Committee meetings. Record and maintain minutes to reflect decisions/actions. Performs special projects as deemed necessary for the continued improvement in efficiency and effectiveness of the PRC Department. Maintain professional and technical knowledge by: attending seminars, workshops, conferences etc. Establish and maintain an effective filing & tracking system. Participates in development of new systems and practices. Completes monthly reports and statistical data required. Use tact and courtesy when dealing with clients, vendors and other agencies. Maintains confidentiality Other duties as assigned. Relationships and Authority: This position has no supervisory authority. Working Environment and Physical Demands: This position is in a professional office environment. This role routinely uses standard office equipment such as computers, phones, printers, scanners, and photocopiers. Stressful environment in dealing with clients, vendors and other service agencies. Sits, stands, bends, lifts and moves intermittently during work hours. Is subject to emotionally upset patients, family members, personnel and visitors. Qualifications: Minimum: High school diploma or GED. One year clerical and/or receptionist or 6 months in a medical setting. Knowledge of medical terminology and medical office practice and procedures. Knowledge of Medicare/Medicaid, Social Security Administration, County, State and Tribal health programs. Computer proficiency in Microsoft Word, Excel, and PowerPoint. Demonstrates excellent written and oral communication skills. Valid driver's license and be insurable. Successfully pass drug and alcohol testing, motor vehicle, education, character, and criminal background checks. Able and willing to travel. Preferred: Associate's degree or relevant Certificate in Medical Office Assistant, Medical Assistant or related field Two years of medical office experience One year or more experience working with Native Americans or Native American organizations Knowledge and understanding of Public Law 93-683: Indian Self-Determination Act. Preference will be given to Ponca Tribe of Nebraska members or members of a federally recognized tribe. However, all qualified individuals are eligible. The Ponca Tribe of Nebraska is an at-will employer. Tribal Council Approval: 05/17/14, 08/07/22 Human Resources Final: 10/06/22 Job Posted by ApplicantPro
Company:
Ponca Tribe Of Nebraska
Posted:
January 25 on ApplicantList
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More About this Listing: Purchased/Referred Care Clerk
Purchased/Referred Care Clerk is a Clerical Clerk Job at Ponca Tribe of Nebraska located in Norfolk NE. Find other listings like Purchased/Referred Care Clerk by searching Oodle for Clerical Clerk Jobs.
Purchased/Referred Care Clerk is a Clerical Clerk Job at Ponca Tribe of Nebraska located in Norfolk NE. Find other listings like Purchased/Referred Care Clerk by searching Oodle for Clerical Clerk Jobs.