Prc Health Jobs (NOW HIRING)

Join our team at the Tuolumne Me-Wuk Indian Health Center, where we offer more than just a job – we provide a community-focused environment with competitive salaries, exceptional benefits, and a true work-life balance.

Our comprehensive benefits package includes medical, dental, vision, and a 401(k) plan, ensuring you and your family are well cared for. Enjoy farm-to-table food through our food distribution program, giving you access to fresh, nutritious options. Plus, take advantage of Indian Health Service Loan Forgiveness opportunities to advance your career while reducing your student debt.

Located in the heart of California's Sierra Nevada foothills, our location offers not just a fulfilling career but the chance to explore a region full of stunning landscapes and outdoor recreation. Spend your days helping others grow professionally and your evenings and weekends hiking through serene mountain trails, kayaking on pristine lakes, or enjoying the charm of historic Downtown Sonora. With its vibrant culture, unique shops, and year-round festivals, you'll find endless ways to connect and thrive.

Whether you're seeking professional growth or outdoor excitement, Tuolumne County is the perfect place to build your future. Apply today and start your next adventure with us!

TUOLUMNE ME-WUK INDIAN HEALTH CENTER

POSITION DESCRIPTION

POSITION TITLE:                           Purchased Referred Care (PRC) Specialist

REPORTS TO:                                   PRC Manager

SUPERVISES:                                  None

POSITION STATUS:                      Non-Exempt

BENEFITS:                                         Per Policy

UPDATED:                                         September 20, 2024

POSITION SUMMARY:

The incumbent assists with screening clients for eligibility and patient registration according to IHS rules and the Board of Directors' care guidelines. They help monitor PRC funds and support clients with medical, behavioral health, and dental billing questions and claims. All services are conducted with strict confidentiality, adhering to HIPAA regulations and ensuring information is shared only on a need-to-know basis with Clinic staff and external providers.

PRIMARY RESPONSIBILITIES: (include but are not limited to the following)

The role involves interviewing clients of TMWIHC to assess their eligibility for Indian Health Service (IHS) benefits, collecting necessary documentation, and preparing Purchased Referred Care (PRC) authorizations. This includes conducting inquiries about patients' eligibility, maintaining both client service and PRC registers, and ensuring these records are reconciled and reported monthly. The PRC Specialist must also update the deferred services log and work closely with medical and dental departments to manage specialty referrals and associated costs.

A key part of the job is identifying and monitoring alternative payment sources for patients, providing guidance, and making referrals to the Social Services Coordinator for additional support. The PRC Specialist is also responsible for processing and forwarding PRC purchase orders, preparing denial letters for ineligible patients, and maintaining PRC eligibility files. Ensuring all patient interactions and written communications comply with HIPAA standards for confidentiality is critical, with interviews conducted in private settings to protect patient information.

Additionally, the PRC Specialist runs monthly, and special reports as directed by the PRC Eligibility Coordinator and is expected to have a strong understanding of the Health Center's goals, demonstrating enthusiasm for its success. The role also includes performing other duties as assigned, requiring flexibility and a commitment to supporting the Health Center’s mission.

QUALIFICATIONS:

Minimum Qualifications:

Education and Experience:

Pattern I: High School Graduate or GED and one (1) or more years’ experience in PRC eligibility. Experience with Microsoft Office software is required.

Or

Pattern II: High School Graduate or GED and one (1) or more years’ experience in clerical work.

• Associate of Arts with classes in Business or other related major can substitute for experience

Preferred Qualifications:

Experience working with the EHR computer systems is preferred.

Experience working with Native American population in a healthcare setting preferred.

PHYSICAL REQUIREMENTS:

This position requires walking, standing, and sitting for prolonged periods of time; pushing, pulling and lifting up to 30 pounds; manual dexterity for operation of computer and phones; hearing, talking, and good verbal and written communication skills; repetitive motions of the wrists, hands, and fingers; walking on uneven ground; operation of medium-weight equipment. This position requires the ability to safely operate a motor vehicle.

INDIAN PREFERANCE:

Preference in filling vacancies will be given to qualified Native American or Alaskan Native Applicants, in accordance with the Indian preference Act (Title 25, U.S. Code Section 472 and 473) and Public Law 93-638, provided the applicant has submitted appropriate verification of Indian preference for employment.  In House postings include Tribal Voting Members. 

All positions require sensitivity to Indian traditions, customs, and socioeconomic needs, and ability at times to meet and deal effectively with numerous tribes and varied cultures, which requires tact, courtesy, discretion, resourcefulness, and good judgment in handling functions of a sensitive nature.  

*Employment is contingent on passing pre-employment TB test, background check and drug testing.

Tuolumne Me-Wuk Indian Health Center is an Equal Opportunity Employer.