Purchased Referred Care (PRC) Clerk

The PRC Clerk works in the Health Support Services Department under the direct supervision of the PRC Supervisor. In the absence of the PRC Supervisor, the PRC Clerk reports to the Chief Executive Officer (CEO) of Health and Human Services. The PRC Clerk is responsible for the commitment of Purchased Referred Care funds to support the direct medical care of eligible clients. Qualified candidates will be responsible for learning and using all RPMS packages that pertain to the PRC Department. Knows all applicable policies and current levels of care, documents, events, maintains filing, confidentiality and security of records. Works closely with PRC Managed Care Committee and Providers to ensure that policies and levels of care are appropriate and administered appropriately. Works with the Director of Quality Management and Outreach Administration to ensure compliance with Accreditation Association for Ambulatory Health Care (AAAHC) Standards.

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1. Is responsible for making sure patients are eligible for PRC services before any cost is incurred by following all current policies.

2. Works with the courier to make sure all mail is delivered to the appropriate clinics.

3. Enters PRC denials into the Resource Patient Management System (RPMS) system in a timely manner.

4. Assists Referral Clerk with entering referrals into the RPMS system as needed. Efficiently send Medi-Cal a letter within 5 days and recheck in 30 days.

5. Closes referrals as needed.

6. Decides for PRC Managed Care Committee meetings as well as take minutes, prepare packets, and prepare the agenda.

7. Reconciles all lab bills against lab orders as they come in.

8. Works closely with the Continues Quality Improvement (CQI) Department to assure compliance with all AAAHC, Health Insurance Portability and Accountability Act (HIPAA), and Government Performance and Results Act (GPRA) standards.

9. Be available and able to efficiently provide transportation to clients for appointments as requested.

10. Adheres to Tribe’s and Program’s confidentiality and personnel policies.

11. Be available for local and out of the area travel as required for job related training and various activities.

12. Attends all required meetings, trainings, and functions.

13. Be polite and maintain a priority system in accepting other job-related duties as assigned.

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1. Demonstrated ability to work effectively with Native American youth and family members in culturally diverse environments.

2. Displays the ability to establish and maintain harmonious working relationships with other employees and the public.

3. Demonstrates the ability to manage time well and work under stressful conditions with an even temperament.

4. Demonstrated ability to understand and follow oral and written instructions.

5. Basic knowledge of the RPMS and eClinical preferred.

6. Experience and/ or working knowledge of insurance billing/payment procedures preferred.

7. Experience and/ or working knowledge of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)/ Current Procedural Terminology (CPT) coding system preferred.

8. Basic knowledge of medical terminology, and anatomy or physiology preferred.

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1. Must have a high school diploma or equivalency.

2. Must have basic office skills to include tele-communications, typing, telephone, filing, keyboard, copiers, computers, etc.

3. Must have excellent mathematical skills and communication skills both oral and written.

4. Must have good time management skills.

5. Must adhere to confidentiality and HIPAA policies.

6. Must provide documentation of immunity to measles and rubella or become vaccinated with the recommended vaccine and Hepatitis B vaccine and test annually for Tuberculosis (TB). Must have an annual health examination.

7. Must be a self-starter, well organized, and willing to learn new skills.

8. Must possess a valid driver’s license, good driving record, and be insurable by the Tribe’s insurance carrier.

9. Must successfully pass a pre-employment drug screening test.

10. Must adhere to a pre-employment background check through Crimcheck and/or FBI Fingerprinting if required.

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Tribal Preference Policy: In accordance with the TERO Ordinance 93-0-01, Tribal Preference will be observed in hiring.

Veteran’s Preference: It shall be the policy of the Karuk Tribe to provide preference in hiring to qualified applicants claiming Veteran’s Preference who have been discharged from the United States Armed Forces with honorable and under honorable conditions.

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