Job Description

Salary Pay Range:$24.60-$31.84

Essential Functions:

• Coordinates benefits with provider through means of patient referrals, discussing individual cases to ensure continuity of care and follow up of care.
• Ensure the integrity of data entered for PRC check processing; assists with claims processing, pre-report, document control register, vendor payment, vendor claim report, object class code report, and checks printed report.
• Performs administrative duties assigned to the PRC function such as: PRC deferred services reports, assists with processing catastrophic caseload, maintains records, files as required and assists with mailing checks and scanning PRC information into designated system.
• Coordinates benefits and assists Tribal Members/PRC with plan changes to ensure proper use of all network discounts and alternate resources available.
• Works closely, communicating and coordinating information with PRC staff.
• Maintains TTF deferred services log.
• Administers Tribal Trust Fund money for deferred services and direct care patients as directed.
• Tracks and generates patient warning letters for patients not in compliance with PRC and tribal member health program guidelines.
• Documents PRC refunds in a timely manner.
• Mails Vendor Payment document and Vendor Denial Correspondence
• Issues payment denials for PRC and tribal member health program
• Exports TPA PRC check file via RPMS to FileZilla.
• Ensures proper internal control and security of PRC and Tribal Trust Fund checks.
• Loads, verifies accuracy and processes claims for Tribal member health program, manually and via an imported file from the TPA.
• Provide outreach and enrollment assistance to those eligible to access health coverage through Cover Oregon.
• Act as an advocate for patients seeking health care by explaining, teaching and enrolling

patients in an alternative resource program.

• Implement a screening, interview process and policies for maximum identification of possible applicants.
• Assist the applicant with any questions regarding health insurance, healthcare access and other resources.
• Disseminate information about low and no-cost health insurance to families.
• Receive referrals from collaborating and partner agencies.
• Acquire any information concerning alternate resources.
• Advocate effectively for needs of families.
• Present health concepts to individuals and small groups.
• Attend meetings and trainings including; but not limited to, Tribal general council meetings and organization meetings.
• Prepare monthly quantitative and qualitative report on application assistance activities.
• Assist with retention activities by making retention follow up phone calls, conducting surveys.
• Coordinates planning for all on-site and off-site meetings and events.
• Bring feedback from patient experience to improve access to health care.
• Maintains patient/client correspondence and follow-up files.
• Refer patients/clients to other available alternate resources when needed.
• Attends community events to promote, educate and enroll families into various health insurance programs.
• Participates in discussion about confidential/sensitive matters, maintains confidentiality of patients at all times.
• Performs a variety of other duties as assigned by supervisor.

Education, Experience, Licenses, Registrations, and Certifications:

• Requires a high school diploma or GED required. Associate’s degree preferred.
• Requires two (2) years of office and clerical experience.
• Must maintain a valid Oregon driver’s license or obtain one upon hire, qualify for the Tribe’s vehicle insurance, and provide proof of personal vehicle insurance.

Qualifications:

• Requires knowledge of Medicaid, Medicare and other insurance guidelines and regulations.
• Must have excellent communication, influencing and presentation skills.
• Must become a Certified Application Assister through Oregon Health Authority and certified through the Federally Facilitated Marketplace within 6 months of hire.
• Must be able to read and understand technical documents.
• Must be a self-starter, strong leader, conceptual thinker with ability to advise and challenge.
• Excellent analytical and decision making skills required.
• Knowledge of ethical and legal requirements and restrictions pertaining to the maintenance of client records, as well as facility policies, HIPAA and other federal regulations.
• Requires considerable tact with daily patient contact; approving or denying authorization of payment for PRC services, encouraging patients to apply for alternate resources, gathering information regarding patient insurance, providing information regarding PRC system, eligibility and process.
• Knowledge of health care and social service resources preferred.
• Requires working knowledge and proficiency in use of office equipment and computer software such as Microsoft Word, Excel, Power point, and Outlook.
• Requires excellent verbal and written communication skills, business and telephone etiquette.
• Must have excellent organizational skills, attention to detail and record keeping skills.
• Must have ability to respond courteously and tactfully to complaints and client requests, and to maintain confidentiality.

Environmental Factors and Conditions/Physical Requirements:

• Continually requires the ability to express or receive detailed information or important instructions through oral communication.
• Continually requires working with fingers rather than the whole hand or arm. Requires repetitive movement of wrists, hands and/or fingers. Often requires walking or moving about to accomplish tasks.
• Requires standing and/or sitting for sustained periods of time, raising objects from a lower to a higher position and/or moving objects horizontally.
• Occasionally requires lifting of up to 20 pounds.
• Due to the nature of the interactions with other employees and the public we serve, employees may be required to provide documentation of, or receive, certain health vaccinations.
• This position is frequently subject to inside environmental conditions which provide protection from weather conditions, but not necessarily from temperature changes, and is occasionally subject to outside environmental conditions.
• May be called upon to serve as a Disaster Reservist during Emergencies, or when the Tribal Emergency Operations Center is opened.
• Local travel is occasionally required. Travel outside of the state is infrequently required.

Background Check:

• Candidates for this position will be subject to criminal and character background checks and may be subject to fingerprinting.