Purchased/ Referred Care Clerk

Description

Central Valley Indian Health, Inc. (CVIH) is seeking qualified candidates for the position of Purchased/ Referred Care (PRC) Clerk. The incumbent screens clients for determination of eligibility and insurance or other alternate resources. Conducts patient registration in accordance with CVIH and Indian Health Services (IHS) policies. Tracks PRC enrollment and assists in monitoring PRC funds and reconciling reports.

PRIMARY RESPONSIBILITIES:

• Obtain documentation to prepare authorization or denial for services. Prepare denial letters to ineligible clients and respond to routine inquiries/requests about the patients regarding eligibility and patient registration.
• Maintain Purchased Referred Care (PRC) register and reconcile cancel purchase order routinely.
• Identify and monitor alternative sources of payment and inform patient, providers and make referrals to Patient Representative for follow-up.
• Work closely with Medical & Fiscal departments regarding specialty referrals and other health services.
• Run monthly reports and special reports and/or projects for Supervisor.
• Post to RPMS all pharmacy, lab, and purchase orders on a monthly basis. Run referral reports to reconcile with hard copy for purchase order requests, close documents that have been paid and export data to IHS on a monthly basis.
• Prepare patient/account payment processing for CVS Caremark, Quest Diagnostics and other vendors.
• Process and forward all purchase orders for payment to accounts payable in accordance with Memorandum of Agreement and other contracted deadlines.
• Verify eligibility of patients on Monthly Prescription Billing report.
• Track patient's reimbursements who have received their glasses or contacts through CVIH Optical or other outside source.
• Work with eligibility department for notification on changes for name, insurance, community updates in RPMS & ECW.
• Maintain confidentiality and a positive image for CVIH by greeting clients in a professional manner.
• Scan all patient letters sent to patients regarding payment status, reasons for denial, information needed, etc. into eClinicalWorks (ECW).
• Communicate in a friendly and professional manner to others. Provide excellent service/support to all patients, employees, and outside contacts.
• Work with fiscal department to get in contact with patient or provider for uncashed checks.
• Maintains CVS Caremark pharmacy as needed.
• Any other duties assigned by his or her direct supervisor or CVIH Administration.

Requirements

1. High School Diploma required. Associates degree in Business or Accounting preferred.
2. Two years' experience in accounting or bookkeeping required. Knowledge of processes and IHS eligibility, medical billing, insurances will be considered in lieu of experience.
3. Proficiency in typing, filing, medical terminology, word processing, Excel, email and 10-Key stroke.
4. Able to assume individual initiative, accept supervision and follow directions.
5. Requires an awareness and keen appreciation of Indian traditions, customs, and socioeconomic needs; and ability at times to meet and deal effectively with Indian Health Organizations consisting of numerous tribes with varied cultures which requires tact, courtesy, discretion, resourcefulness, and good judgement in handling functions of a sensitive nature.

Preference in hiring is given to qualified American Indians in accordance with the Indian Preference Act (Title 25, U.S. Code, Section 472 and 473). Applicants claiming Indian preference must submit verification of Indian heritage certified by tribe of affiliation or other acceptable documentation.