Purchased Referred Care Technician - Smith River
For a complete job description download the attached PDF.
Position shall be responsible for initiating, tracking, and processing “payer of last resort” health insurance claims according to United Indian Health Services Contract Health Services (CHS) guidelines.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. • Maintains Contract Health Service files. • Determine if incoming CHS referrals are within the UIHS approved priorities. Ask for assistance from the Patient Accounting Manager when needed. • Prepare and follow up on referrals that need medical and dental review. • Determines if clients meet Contract Health Services eligibility requirements, including referral to Alternate Resources for screening and application if eligible. Also acquire a copy of Indian documentation for the CHS file. • When necessary, contact outside providers to set up appointments for approved cases, ask for an estimate of charges, and notify clients of scheduled appointments. Create purchase orders for eligible approved referrals. • Communicates and corresponds with outside agencies and clients regarding claim submission. • Communicates and corresponds with clients/providers regarding status of Contract Health Services claims. • Communicates and corresponds with UIHS providers to clarify Contract Health Services referrals and address case status questions. • Tracks Contract Health Services cases through the processes of: appointment, procedural scheduling, outcome, third party insurance eligibility determination, and final claims payment processing. • Tracks and submits claim reimbursements through Contract Health Services. • Prepare and submit Catastrophic Health Emergency Fund (CHEF) cases following guidelines from IHS. Notify supervisor of possible pending CHEF cases so they can be reported to the Patient Registration/CHS committee. • Prepares periodic reports on claims reviewed, pending, and processed to completion. • Attends and participates in CHS related meetings at both Board and Administrative levels as needed.
Must have ability to operate computer system with standard and job specific office software packages. Ability to type 45wpm Must have ability to operate standard office equipment (typewriter, fax, copier, etc.). Must be able to work with American Indian people and be sensitive to their culture. Must possess ability to communicate both orally and in writing to a high level. Must have an understanding of basic medical terminology.
EDUCATION and/or EXPERIENCE: Educational degrees must be from a US Department of Education accredited school Level I –
• Must have High school diploma or general education diploma (GED); and • 0-1/yrs of clerical office or related experience that indicates the ability to learn the skills necessary to perform the duties of the position. Level II –
• Must have High school diploma or general education diploma (GED); and 1-3/yrs experience working with contract health or other related areas. • Knowledge of contract health and able to perform the duties of the position. • Ability to work independently and as part of a team. • Experience in a health care setting preferred. • Able to train level I.
Level III – • Must have High school diploma or general education diploma (GED); and 3+yrs of related experience and/or training in contract health services and has the ability to perform all the duties of the position. • Ability to work independently and as part of a team. • Experience in health care setting preferred. • Able to train level I or II.