|Program:||Fallon Tribal Health Center||Salary Grade:||GS – 7|
|Supervisor:||Purchased/Referred Care Manager||Salary Range:||$14.42 – $17.22|
|FLSA Status:||Exempt Non-Exempt Public Safety||Position Type:||Choose an item.|
The PRC Clerk provides administrative support and back-up service for the PRC manager to ensure the maximum utilization of purchased/referred care funds by eligible clientele and assists with PRC eligibility determination and use of all available alternate resources and to coordinate referrals with providers outside the Health Center.
ESSENTIAL DUTIES & RESPONSIBILITIES
- Determines patient eligibility for care under the PRC Program, including residency requirement, tribal enrollment, etc.
- Process referrals using the appropriate referral system through RPMS or other EHR system which shall include coordinating referrals for approval and setting appointments for referrals for patients who are referred out by an FTHC provider.
- Ensure PRC referrals meet the requirements according to the IHS/FTHC medical priority levels and applicable laws and policies.
- Works with the appropriate officials in providing appropriate referral data for contract requirements for physician, hospital, laboratory, radiology, ambulance and other health services.
- Determines cases of patients that may qualify for alternate resources and /or Catastrophic Health Emergency Funds (CHEF).
- Maintains a PRC referral and funds commitment register in RPMS or EHR to ensure the accurate accountability of funds and proper fiscal coding procedures.
- Administers Purchased/Referred Care referral systems for individual patients including coordination of approval system and records management.
- Prints updated face sheet of patients and completes verifications for IHS, Medicare, and Medicaid.
- Maintains office files according to established functional files system. Searches for and withdraws material when requested.
- Reviews patient collection notices turned into the PRC Office and will contact collection agencies, discuss settlement offers, and make collection payment on behalf of eligible patients, as well as coordinating with IHS on payments (if applicable).
- Educates patients on the PRC process when they come into office, as well as walking patients through patient statements and/or collection notices to help understand the program and PRC process.
- Other job related duties as assigned by the supervisor.
KNOWLEDGE, SKILLS & ABILITIES
(To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions)
- Ability to work effectively with Native American people in culturally diverse environments.
- Ability to manage time well and work under stressful conditions with an even temperament.
- Ability to establish and maintain harmonious working relationships with other employees and the public.
- Ability to understand and follow oral and written instructions.
- Knowledge of the Greenway EHR or Resource Patient Management System (RPMS) preferred.
- Knowledge of insurance billing/payment procedures preferred.
- Knowledge of medical terminology, and anatomy or physiology preferred.
- Knowledge of organizational structure for a PRC Program, policies, payment processing, etc.
- High School diploma or GED.
- Two (2) years’ work experience handling Purchased/Referred Care process or other related healthcare or health insurance processes, including processing vendor payments.
Fallon Paiute-Shoshone Tribe and Native American/Indian Preference: Employment preferences to members of the Fallon Paiute-Shoshone and to members of federally-recognized Indian Tribes shall apply to this position pursuant to the Tribe’s Personnel Policies. Persons of Tribe and/or Indian ancestry and wish to claim these employment preferences should submit a copy of the Tribal Enrollment Card/Certification indicating the name of the Tribe they are enrolled with.
U.S. Veteran’s Preference: Preference to opportunities to veterans honorably discharged from the United States Armed Forces shall apply to this position pursuant to the Tribe’s Personnel Policies.
Equal Opportunity Employer: The Fallon Paiute-Shoshone Tribe does not discriminate on the basis of race, color, national original, sex, religious preference, age, handicap, marital status, political preference, genetics or membership or non-membership in any employee organization, except as allowed by Federal and/or Tribal Law.
Drug Free Workplace: The Fallon Paiute-Shoshone Tribe is a drug-free workplace. All employees are subject to a pre-employment and random drug screens.
Driving Record: Employees who drive tribal vehicles must have a valid Nevada Driver’s License, be insurable under the Tribe’s vehicle insurance program, and must also provide a DMV printout annually.
Background Checks: All employees must be able to pass a background check per the Tribe’s Background Check Policy.
Position Description Limitations: This position description does not constitute an employment agreement between the Tribe and the employee, and is subject to change by the Council as the needs of the Tribe and the requirements of the job change. This position description is not intended to present a descriptive list of the range of duties performed by any employee in this position and is not intended to reflect all duties performed within the position.