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Purchase and Referred Care Manager-Reno-Sparks Indian Colony

Reno-Sparks Indian Colony

Job Opening Announcement

Job Title: Purchase and Referred Care Manager 

Job Vacancy #: RSIC 098-22

Department: Tribal Health Clinic 

Job Status: Full-time; Exempt

Salary: Up to $68,682 annually 

Opening date: 06/09/2022 

Closing date: Open until filled

Position Summary:

This position is responsible for determining patient eligibility for Purchased and Referred Care (PRC) based on Indian Health Service guidelines, maintain and implement PRC policies and procedures established by the RSIC Tribal Council, authorize and coordinate payment for services provided, submit cases to appropriate agencies for additional funding or reimbursement, prepare various statistical reports as required.

Duties:

· Maintain and implement PRC policies and procedures established and approved by the

· RSIC Tribal Council, using the Indian Health Service guidelines as a reference;

· Review information provided by the patient to determine eligibility for PRC as established under the guidelines;

· Enter accurate patient information into the appropriate PRC computer system;

· Inform Patient Benefit Coordinators to assist patients when necessary to apply for alternate resources;

· Prepare agenda and cases for the weekly PRC Managed Care Committee meetings and record the committee's informational requests or actions update needs of the meeting;

· Upon approval of referrals, issue PRC Purchase Orders, obligate funds, coordinate appointments with vendors and patients, arrange transportation;

· Prepare necessary correspondence to patients and vendors;

· Supervises the preparation and processing of denial letters;

· Provide training and orientation to the PRC Clerks and vendors to insure the coordination of billing and payment of outside services;

· Approves PRC Purchase Orders to Fiscal Intermediary for payment after appropriate documents have been received and all payments to vendors from alternate resources have been made first;

· Maintain binder of current Service Contracts with vendors who offer discounted rates as required;

· Assist with necessary actions to insure compliance of patients and participating vendors;

· Maintain accurate PRC Obligation Register of documents issued, amounts obligated, corrected, canceled or paid and current unobligated balance; generate PRC Obligation Register and PRC Document Control Register on a weekly and monthly basis and submit to the RSTHC Director;

· Prepare various statistical reports as required;

· Supervise the maintenance and organization of patient charts for required documentation, proper assembly and perform periodic chart reviews;

· Maintain Deferred Services Log to be submitted annually to I.H.S. Area Office to request additional funding;

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· Submit eligible cases annually to IHS for reimbursement from the (CHEF) Catastrophic Health Emergency Fund;

· Provide coverage for the PRC Clerk(s) when necessary;

· Participate in staff development and in-service training activities;

· Other fiscal duties as assigned by the RSTHC Director;

· Designs and implements performance improvement indicators and monitors progress.

· Performs other job-related duties at the request of the RSTHC Director.

Minimum Qualifications:

· Three years of medical business office or comparable experience;

· Must have GED or High School diploma;

· Knowledge of medical terminology, diagnosis coding and medical billing procedures required;

· Knowledge of IHS Purchased and Referred Care guidelines, policies and procedures required;

· knowledge of availability and utilization of alternate resources such as Medicare,

· Medicaid, CHIP and private insurance;

· organizational skills and ability to maintain accurate records and filing systems;

· ability to type 45 WPM accurately and use 10-key calculator by touch;

· excellent spelling, grammar and reading comprehension; strong written, oral and interpersonal communication skills;

· data entry, word processing and basic computer skills;

· ability to maintain strict confidentiality of records and information;

· must be willing to submit to and pass a pre-employment drug screening test and possess a current CPR card or billing to acquire on within 6 months of employment.

Submit application to: Reno-Sparks Indian Colony

Human Resources Department

Attn: Esther Sanchez

34 Reservation Rd

Reno, NV 89502

Phone: 775-785-1303

Fax: 775-785-8779

Email: esanchez@rsic.org

Indian Preference:

Hiring preference will be given to qualified tribal members of Reno-Sparks Indian Colony followed by members of other federally recognized tribes. The Reno-Sparks Indian Colony requires a designated candidate to successfully complete a pre-employment drug screen, criminal background check which may require fingerprinting, and confirmation of professional references and certifications.