Purchase Referred Care Specialist
Any individual who receives an offer of employment or will receive a payroll check are required to submit to a drug and alcohol test as a condition of obtaining employment.
Mille Lacs Band Member/American Indian preference applies
The Purchase Referred Care (PRC) Specialist is responsible for maintaining a comprehensive authorization and payment system in accordance with existing Federal regulations governing the PRC program (formerly Contract Health Services and the Mille Lacs Band and Indian Health Services (HIS) contract specifications.
• High school diploma or GED is required.
• Two years of post-secondary education preferred and/or one to three years of experience.
• Experience with computers, medical terminology, ICD10 coding and PRC regulations is preferred.
• Knowledge of basic accounting principles.
• Ability to read and write sufficiently to utilize computer, keep accurate records and interpret computer print outs and billing manuals.
• Ability to work and communicate effectively with patients, families, public agencies, providers and co-workers.
• Knowledge of Data Privacy Act and ability to maintain strict confidentiality of patient, Clinic and Band information.
• Experience in and sensitivity to Native American culture.
• Must have a current valid driver’s license.
• Must be insurable under the Mille Lacs Band Drivers Insurance policy.
• Must pass a background check.
• Must pass a pre-employment drug and alcohol test.
DUTIES AND RESPONSIBILITIES:
• Receive, evaluate, recommend (as appropriate), and process Purchase Referred Care payment requests.
• Authorize payment for Purchase Referred Care.
• Issue denial letters to patients and providers when services are denied.
• Work closely with patients, providers and other agencies to keep PRC accounts payable current.
• Maintain PRC responsibilities within the Referred Care Information System (RCIS).
• Maintain current knowledge base in regulations, medical terminology, coding and IHS/Band systems.
• Other duties as assigned.
• Nature of work is such that incumbent experiences infrequent periods of moderate while dealing with patients.
• Work is exclusively in doors in a controlled climate area.
• Little threat of personal danger or risk.
• Hours are typically 8-5, but possibly with some extra hours.
• Local travel may be required.