Prairie Band Potawatomi Nation
  • 20-Sep-2018 to 31-Oct-2018 (CST)
  • Mayetta, KS, USA
  • Salary
  • Full Time

CLOSING DATE: Open until filled
GRADE: 11
TIER: 1
DEPARTMENT: Health Center
REPORTS TO: Nursing Supervisor

 

SUMMARY:

Serves as a link between the providers, patients, and the Health Center by coordinating the Purchased Referred Care (PRC) Program which receives, processes and places referrals with approved network providers in an organized and process-oriented manner. Must effectively communicate with internal and external clients and providers. Must be willing to work in a fast-paced and demanding environment with the professional skillset to manage discouraged clients.

ESSENTIAL DUTIES:

  • Provides referral services to patients regarding specialized care to outside providers and serves as a point of contact for patient inquiries concerning specialty referrals.
  • Review details and expectations about the referral with patients, and assist with potential issues related to the health care system such as financial and social barriers.
  • Determines patient eligibility for care within the PRC program and as a prerequisite for the authorization of funds.
  • Act as system navigator and serves as a point of contact for patients and families while assuming an advocacy role on the patient's behalf with carriers to ensure approval of necessary services for the patient in a timely manner.
  • Applies rules and regulations of the PRC program as set forth in approved policies.
  • Ensures that referrals are addressed in a timely manner utilizing the RPMS system.
  • Ensures Medicare Like rates are applied to applicable claims.
  • Participates in the decision making process concerning denial or payment for services based on eligibility criteria.
  • Assists the Patient Advocate and other staff with identifying alternate resources available to patients.   
  • Administers the day-to-day activity required by the PRC program by initiating purchase orders.
  • Ensures consistency and correct use of documents coding, assures the issuance of purchase orders to vendors are met within specified time limits.
  • Maintains an up-to-date tracking system with appropriate documentation of referrals to promote team awareness and ensure patient safety.
  • Identifies and utilizes community resources as applicable.
  • Maintains HIPAA compliance and patient privacy
  • Maintains monthly and quarterly special reports to administration and the PRC committee.
  • Maintains correspondence files; including supporting documentation and ensures reconsideration requests are made available following a denial.
  • Serves as a member of the PRC Committee and recommends updates or changes to PRC policies and guidelines as needed.  
  • Assists with coordinating contracts with outside vendors and providers.
  • Prepares and submits CHEF cases according to PRC policy and IHS guidelines.
  • Directly supervises two (2) employees, which includes but is not limited to: assigning and reviewing work, instructing, training, establishing schedule, setting objectives, recommending hiring and disciplinary action.
  • Works cooperatively within the Office, Prairie Band Potawatomi Nation, and other agencies; as needed.
  • All other duties as assigned.            

To qualify for this position, applicants must meet all requirements by the closing date of this announcement.

MINIMUM REQUIREMENTS:

  • Associates degree in the field of Medical Administration, Nursing, Business or related field.
  • One to two years of related experience in a medical office and/or insurance billing setting.
  • Must have valid Kansas driver's license and be insurable with the Nation's insurance
  • Must possess ability to communicate professionally; both orally and in writing with a service-oriented approach, sometimes in stressful circumstances.
  • Must possess basic knowledge of medical terminology and health insurance billing terms.
  • Must possess professional work ethics, manner, and appearance.
  • Must possess ability to operate general office equipment.
  • Must be available to work the assigned schedule of M-F, 8:00A-4:30P and available as needed to work a flexible schedule to meet the demands of the position, which may include nights, weekends, holiday and overtime.
  • A record of satisfactory attendance and performance in all prior and current employment as evidence by positive employment references from previous and current employer.

PREFERRED QUALIFICATIONS:

  • Bachelor's Degree in the field of Medical Administration, Nursing, Business or related field.
  • Two to three years related experience in a medical office and/or insurance billing setting.
  • Previous supervisory or management experience.

PHYSICAL, MENTAL, & ENVIRONMENTAL DEMANDS: 

  • Ability to develop positive working relationships with others, including members of the public
  • Ability to maintain high level of privacy and confidentiality of individuals and families
  • Ability to operate general office equipment, including but not limited to: 10-key calculator, telephone, computer and operating systems, computer software programs (Microsoft Office programs), fax/copier machine
  • Able to read, write and speak English
  • Ability to work efficiently in a highly team-team oriented environment
  • Ability to work in a high-stress, deadline oriented environment
  • Attend out-of-state/out-of-town training periodically to enhance job performance and knowledge
  • While performing the duties of this job, the employee is regularly required to have full range of mobility in upper and lower body; be able to reach overhead; be able to work in various positions, including stooping, standing, bending over, sitting, kneeling and squatting for extended periods of time; be able to lift, pull and push materials and equipment to complete assigned job tasks; and be able to frequently lift 20 pounds of weight throughout the assigned workday

BACKGROUND CLEARANCE REQUIREMENTS:

  • Background Investigation with Adjudication
  • Pre-employment Drug Screening
  • Tuberculosis (TB) Screening

Note:  This job description should not be construed to imply that these requirements are the exclusive standards of the position.  Incumbents will follow any other instructions, and perform any other related duties, as may be required.  The Prairie Band Potawatomi Nation reserves the right to revise this job description at any time.  The job description is not to be construed as a contract for employment.

INDIAN PREFERENCE EXERCISED

Prairie Band Potawatomi Nation
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