Purchase and Referred Care Specialist

RESPONSIBILITIES AND DUTIES:

1. Determines patient eligibility for care under the PRC Program.

2. All requests for PRC payments a PRC referral must be initiated by using the automated Referred Care Information System (RCIS) this includes: referrals treated at the Elbowoods Memorial Health Center and referred out by a physician, ER services, and IP admissions that are requested for payment.

3. Ensure PRC referrals meet the requirements according to the Aberdeen Area HIS/PRC Medical Priorities.

4. Administers the daily activities required of the PRC approved services by initiating PRC medical purchase orders.

5. Issues denial letters for care that is denied payment by the Tribe.

6. Works with the SU professional and Para professional staff in providing appropriate data for the SU contract requirements for physician, hospital, laboratory, radiology, ambulance and other health services.

7. Determines cases of patients that may qualify for alternate resources and /or Catastrophic Health Emergency Funds (CHEF)

8. Liaison functions with patients and providers on the PRC Program.

9. Appointments are scheduled by the PRC Staff for the patients that are referred out for services that are not available at EMHC.

10. Maintains the PRC automated commitment register in the EHR to ensure the accurate accountability of funds and proper fiscal coding procedures.

11. A patient must meet residence requirements, notification requirements, medical priority and use of alternate resource.

12. Administers Purchased & Referred Care referral systems for individual patients including coordination of approval system and records management.

13. Work in accordance with all applicable Indian Health Service rules and regulations, HHHC, compliance with billing standards, and other pertinent regulatory agencies.

14. Assure compliance with standard of accuracy, timeliness, completeness, confidentiality of electronic and hardcopy data.

15. Represents EMHC in a highly professional manner.

16. Establishes positive communications with all departments of EMHC to assure stable operations.

17. Demonstrates respect and understanding of confidentiality for patients, staff and others according to policy and HIPAA regulation.

18. Participates in EMHC staff meetings and other meetings as instructed or deemed necessary.

19. Actively strives to educate the community on the mission, vision and values of EMHC in a positive approach to assist in the growth of the organization and assist our community in its healthcare needs.

20. And other duties as assigned.

QUALIFICATIONS, EXPERIENCE, EDUCATION

• High School diploma, REQUIRED. Must submit copy of degree or transcripts with application.
• Experience and knowledge working with IHS Purchased & Referred Care systems, PREFERRED.
• Thorough knowledge of basic and established procedures related to routine and repetitive aspects of PRC support work, basic medical terminology, forms or reports, respond to routine questions, or perform similar duties.
• Knowledge of basic correspondence methods to assist with correspondence to patients, health care providers and other agencies regarding eligibility, IHS policy and regulation, including letter of denial of claims. Insures confidentiality of patient information.
• Efficient organizational skill and successful completion of tasks under continuing pressure, to meet the deadlines.
• Must be able to interact positively with co-workers, follow instructions, and handle sensitive situation with tact.
• Ability to handle routine tasks daily.
• Computer and equipment knowledge and proficiency, REQUIRED.
• Must be responsible, dependable, and punctual.
• Familiarity with MHA Nation culture, values, and traditions, HELPFUL.
• Must be responsible, dependable, and able to maintain confidentiality of information.
• Must have an acceptable motor vehicle record. A copy of driver’s license and verification of driver’s record from the North Dakota Department of Motor Vehicle, REQUIRED.
• Must submit and clear Criminal Records Background Check.
• Must submit to an Alcohol/Drug Screen and random testing as per policy.
• Indian Preference will apply. Must submit documentation with application to qualify for Indian Preference.
• Veterans Preference will apply. Must submit documentation with application to qualify for Indian Preference.