PRC Technician I

Opening Date:           06/13/2022
Closing Date:             06/27/2022
Job Title:                    PRC Technician I
Salary/Wage:             $19.84/hr.
Tribal Level               17
Location:                    Siletz, OR
Classification:            Full-time, Non-exempt
Job Posting Number: 202244

New employees are required to provide proof of COVID-19 vaccination prior to their first day of employment or submit a request for medical exemption to the Human Resource Manager, prior to starting employment.

Introduction: This position is the lead in facilitating the Purchased/Referred Care (PRC) program.  PRC provides quality services in all aspects of processing claims for patients seeking medical care within the 11-county service area.

Requirements: Associate’s degree in Accounting –OR– an equivalent combination of education and/or experience. Knowledge of: Medical terminology and medical coding processes. PRC rules, regulations and policies. Ability to: Plan, organizing work, and setting priorities to meet strict deadlines and fluctuating patient/client workloads. Interprets IHS/PRC regulations, policies and operating procedures to determine eligibility and allowable program activities. Meet and deal with the public. This includes the ability to establish positive interpersonal relations by exercising tact, diplomacy and mature judgment with a wide variety of individuals including superiors, peers, and subordinates within the tribal organization and outside the tribal organizing with whom the individuals must deal. Convey and obtain information. This includes the ability to provide information to a variety of individuals in a variety of circumstances. Obtain information by asking pertinent questions, identify relevant facts, and determine complex issues. Recognize when immediate response is needed for urgent or emergent services; provide explanations and advice to individuals on a one-to-one basis in a clear, concise and courteous manner. Demonstrate analytical skills. Demonstrate effective computer skills with specific knowledge of spreadsheet applications, data entry, and electronic transmission procedures.

Duties: Ensure that tribal members and eligible dependents, in need of health services beyond that directly available through IHS clinical facilities, are given effective, courteous, immediate assistance in meeting their health needs to the extent possible in a way consistent with understanding of Indian culture, traditions, folkways, mores, personal values and desires, with consideration of resources available to the program. Lead Technician for providing on-going leadership and guidance to other PRC Technicians. Support person for PRC Technician II in their absence, assumes position of authorization and payment approval for uninterrupted payment process. Prepare annual reports, such as; deferred service report, denial system report, quarterly and annual reports, statistical error report, export report, other reports as needed. Coordinate and participate in weekly PRC Gatekeeping meeting; prepare and distributes packets, and processes decision letters to patients. Oversee pharmaceutical benefit plan. Process applications, update membership, and distribute pertinent plan information, such as; membership cards, brochures, mail in envelopes and other information. Enter accurate data for payment process; calculate payment amounts, assign correct CPT and ICD-9 codes with accurate dates of admit and discharge. Review posted data for accuracy, print checks and prepare printed check report, post accurate figures to the Tribal account report. Review all checks a second time for exactness before sending to accounting for Tribal Council signature. Maintain and coordinate all check processing records. Coordinate the annual 1099 report; distributes and maintains accurate records. Maintain PRC W-9 forms; enter information on accounting MIP system. Communicate program policies and guidelines to vendors, staff, patients, Tribal officials, community officials, alternate resource officials and other concerned groups or organizations. Provide program orientation to new providers. Oversee PRC daily tasks, including training and job assignments. Compile and report CHEF (catastrophic) cases to PAO, monitor and review process for alternate resources utilization. Generate statistical data and program reports, Maintain accounts for services required for the efficient operations of the PRC program. Seek legal avenues to pursue Alternate Resources, such as Worker Compensation claims, motor vehicle claims, and Victims assistance claims for program appropriateness. Interpret complex PRC and third party (OHP, Medicare) program rules, regulations, and procedures while maintaining current program guidelines and procedural manual. Oversee account reconciliation of bank drafts use for PRC payment.  Monitor PRC program document, including provider agreements and contract to determine compliance with program policies and procedures. Monitor Out- of -Area Benefits operational budget, track patient eligibility, post payment, complete check requests, scan and maintain all copies of claims & check requests. Monitor Alternate Healthcare operational budget, track patient eligibility, post payments, complete check requests, scan and maintain all copies of claims & check requests. Monitor Orthodontic program budget, track patient eligibility & complete check requests. Manually enter and maintain bank report of weekly check run for accounting. Mail and match EOB’s from MLR and First choice to weekly checks. Generate authorization numbers for HMA claims of approved services and email results to HMA weekly. Process PRC and Health Committee appeals for review monthly, initiate letter to patient, and maintain copies. Review program appeals with the Health Director and determine appropriate program action. Coordinate the development and modification of the CTSI Service Delivery Plan (SDP), alternate resources policies and procedures, and program budget. Review and signs all denials issued, making sure all have accurate dollar amounts and correct reasons for denial issue. Review program documents, including provider agreements and contracts to determine compliance with program policies and procedures. Maintain accounts for services required for the efficient operation of the PRC program. Seek legal avenues to pursue Alternate Resources, such as; Workman’s Compensation claims, Motor Vehicle claims for program appropriateness. Edit and enter new registration update information in RPMS as needed. Other duties as assigned.

All new employees will serve a six-month probationary period to enable the General Manger to determine their suitability as a tribal employee.  After the six-month probation the employee will be evaluated of his/her performance and at that time, it will be, decided if the employee is entitled to a regular employee status.

How to Apply

All applicants must submit a Tribal “Application for Employment Form”, found here:

Employment Application (PDF)
Apply Online

Applications must be received by the closing date of this announcement to receive consideration.

TO RECEIVE CREDIT FOR TRAINING OR EDUCATION, DOCUMENTATION MUST BE PROVIDED.

If applying for more than one position, separate applications will be required for each position.
The high school diploma/GED requirement will be waived for Tribal Elders

Send Applications To

Confederated Tribes of Siletz Indians
Attn: Human Resources Department
P.O. Box 549
Siletz, OR 97380

Fax number: 855-573-1032
Human Resources: 1-800-922-1399 ext. 1274
Website: www.ctsi.nsn.us
Email: hrdepartment@ctsi.nsn.us

Conditions of Employment

The selectee will be required to submit to a urinalysis to screen for illegal drug use before employment.

New employees are required to provide proof of COVID-19 vaccination prior to their first day of employment or submit a request for medical exemption to the Human Resource Manager, prior to starting employment.

May need to provide DMV Driver Record and proof of Automobile insurance.

The Tribe’s Indian Preference Policy will apply. Tribal government will not discriminate in selection because of race, creed, age, sex, color, national origin, physical handicap, marital status, politics, membership, and non-membership in an employee organization.