Entry Level Medical Claims Processor Jobs in Alaska

Medical Social Worker Supervisor

Department: Health Systems Management

Program: Health Systems

Reports to: Health Systems Manager

Employment Status: Full Time

FLSA Status: Exempt

Schedule: 40 Hours/52 Weeks

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

Job Summary

The Medical Social Worker Supervisor is a key member of the interdisciplinary healthcare team at Dena'ina Wellness Center and is responsible for overseeing the daily operations of the Purchase Referred Care (PRC) program. The supervisor provides essential psychosocial support, case management, and advocacy services to un'ina (patients) and their families. The Supervisor position will focus on addressing the social determinants of health that impact the well-being of our un'ina (patient) population. The Medical Social Worker Supervisor ensures the efficient and effective delivery of services related to un'ina eligibility, referral management, and PRC claims processing. The Medical Social Worker will work closely with all members of the healthcare team including Primary Care, Dental, Optometry, Behavioral Health, Physical Therapy, and other specialties to ensure comprehensive and coordinated care as well as ensuring seamless coordination of un'ina referrals and PRC claims. The Supervisor will also provide warm hand offs to non-healthcare Kenaitze Indian Tribe Departments as appropriate to improve the well-being of our un'ina.

Essential Functions

• Assists un'ina and family in understanding referral recommendations and options to facilitate un'ina and families engaging in treatment planning and decision making
• Facilitates appropriate use of Kenaitze Indian Tribe and community resources to best suit the un'ina needs to ensure un'ina centered care and alignment with Tribal traditions and values
• Ensures timely completion of PRC claim review, referral management, and Family Health Resource (FHR) screenings to provide appropriate insurance support services to un'ina
• Provides daily operational oversight of the PRC program, ensuring that all Tribal and Indian Health Services (IHS) procedures are followed accurately and efficiently
• Assess and implements departmental workflows to ensure efficient and timely processing of referrals and PRC claim review and reviews accuracy and completeness of all documentation, records, and data entry
• Communicates with Health Systems Departments and external facilities regarding un'ina referrals and claims
• Identify and resolve issues related to un'ina eligibility and referrals within the PRC program, ensuring compliance with policies and timely access to care
• Participate in interdisciplinary team meetings to provide insight on un'ina needs and potential barriers to care
• Performs duties to include compiling and maintaining reports and statistical information as required
• 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.

Working Conditions

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

Hazards and Atmospheric Conditions

• None

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

List Equipment used for job: Desktop, Printer, Scanner, Phone

List Tools: N/A

Drives KIT or Personal Vehicle: N/A

Travel

• Local
• In-State
• Out-of-State

Qualifications

Education

• Master's degree in Social Work (MSW)

Preferred

• Knowledge and experience working with cultural diversities

License/Certification

• Current, valid Alaska state license as a Licensed Clinical Social Worker (LCSW) or equivalent licensure required
• Must have a valid Alaska State driver's license and must remain insurable under the Tribe's policy, or obtain within 90 days of hire
• Basic Life Support (BLS) certification required, or obtain within 90 days of hire

Special Skills

• Strong organizational and time-management skills
• Proficiency with Microsoft Suite, or obtain training within 90 days of hire
• Conducts business in a service-oriented manner that is attentive, pleasant, respectful and kind when dealing with un'ina, visitors, co-workers and others
• Ability to multi-task, work independently, and meet deadlines
• Knowledge of Health Insurance Portability and Accountability Act (HIPAA)

This position is a Covered Position subject to all requirements of the Alaska Barrier Crimes Act (ABCA) and to the Indian Child Protection and Family Violence Prevention Act, (ICPA). ABCA and ICPA requirements apply and must be complied with at all times in order to remain in the position.