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Purchased Referred Care II/Trainee

Opening Date: January 6, 2022
Closing Date: January 21, 2022
Job Title: Purchased Referred Care Technician II/Trainee
Salary/Wage: $15.10/hr. – $18.71/hr.
Tribal Level: 14-16
Location: Siletz, OR
Classification: Full Time, Non-Exempt
Job Posting Number: 202202

Introduction:

Tech Trainee: This trainee position is to develop an entry-level applicant into a PRC Tech II. When the trainee completes the required training in medical terminology, demonstrates the ability to interpret IHS/PRC regulations, policies, and operating procedures to determine eligibility using the Code of Federal Regulations (CFR) public health law and Tribal health policies and has completed at least one year in the trainee position, with successful evaluations and performance the person will be upgraded PRC Tech II.

Requirements:

Tech Trainee: High School diploma or GED and one year of accounts payable/receivable bookkeeping experience, OR two years of clerical experience. This position works closely with the PRC Tech 1 and PRC Tech II in all aspects of the position duties. Knowledge of: Office procedures and a willingness to complete a medical terminology course, preferred. Word processing and/or ADP principles, preferred. The rules and regulations for Purchased Referred Care, preferred. Able to: Type, file, and use a calculator. Good communication and organizational skills. Work and communicate effectively with a wide variety of people and health agencies.

Tech II: Associates degree in Accounting –OR– an equivalent combination of education and/or experience. Ability to: Interpret Indian Health Service/Purchased/Referred Care (IHS/PRC) regulations, policies, and operating procedures to determine eligibility using the Code of Federal Regulations (CFR) public health law and Tribal health policies. Must be able to work with a wide range of people and communicate effectively and courteously, given proper guidance. Work with strict deadlines and fluctuating patient/client workloads. Plan, organize work, and set priorities, ensuring all phases of job duties are completed accurately. Other: Working knowledge of medical terminology, and medical coding processes.

Duties:

Tech Trainee: Receive applications for PRC assistance. Collect data and verify eligibility.  Maintain accurate, up-to-date PRC cuff account records and commitments. Assemble and mail PRC orientation packets and maintain individual patient files.  Maintain pre-authorization logbook. Distribute medical/dental authorizations, and type denial letters. Maintain PRC general files.  Audit claims for payment to ensure appropriateness of charges. Identify alternate resources and make referrals as appropriate.  Maintain billing and payment records. Communicate with clients and providers on payment application procedures and processing steps. Generate statistical data and samplings. Maintain rapport with vendors. Implement PRC funding priority guides, and independently approve payment of authorizations within such guides. Assist clients in alternative resource application procedures. Maintain adequate supplies and services required for the operation of the PRC program.

Tech II: Respond to individual requests for PRC assistance and determine eligibility. Generate individual claims using accurate claim type, cost coding, object classification coding, and medical priority level to insure accurate claim orders for statistical reports. Prepare and process program correspondence, form letters including: Oregon Health Plan, Out-of-Area (OOA), Gatekeeping, check reimbursement, eligibility, alternate resources, additional information needed, dental pre-treatment, etc. Authorize expenditures for outpatient, inpatient, and dental services, adhering to strict and fluctuating guidelines. Maintain pre-authorization logbook for PRC funding priority guidelines containing six mandatory key components to authorize funds. Code, calculate, and recommend payment of accounts ensuring support services are paid when date of services is authorized i.e. x-ray, lab, ambulance, physician fees, anesthesiology, etc. Assign International Classification of Disease (ICD) code and Current Procedural Terminology (CPT) code. Research and verify that availability of alternate resources are exhausted before payment is made by PRC, requiring explanation of benefits from private insurance, OHP screening, workers compensation, motor vehicle accident (MVA), victims assistance, etc. Submit and track all repriced claims by purchase order number. Record and track all discounts provided and submit all explanation of benefits (EOB) with check process. Convey information throughout the PRC department and clinic staff to ensure weekly operations are done in a timely and orderly manner including: patient updates, restrictions, eligibility status, optical benefits, etc. Develop and revise department forms to support PRC program in communicating in and outside the tribal organization including: enrollment, Indian Child Welfare, education etc. Support other PRC specialists in payment process coding, and financial assessment of payment resources before final payment. Coordinate and distribute vendor usage report to liquidate aged claim orders. Review outstanding aged claim orders and determine appropriate action to liquidate. Create and manage patient care files, requesting treatment plans, chart notes, diagnostic reports, dental x-rays and lab reports for Gatekeeping to review in order to be considered for specialty care. Maintain individual document filing system. Order and maintain office supplies. Close weekly document control register, coordinates weekly documents throughout the PRC department, and mails out notices to vendors for prompt payment of weekly claim generation. Coordinate and generate denial notices, ensuring accurate data is entered and prompt reply is sent.  Guide patients through the appeals process. Refer OHP eligible patients to OHP representative at clinic. Clinic referral tracking to report non-authorized visits. Assume PRC Technician I duties and responsibilities during absences and other duties as assigned by Business Office Manager.

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
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 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.