Job Description

Job Location: Health & Human Services - El Paso, TX 79907
Position Type: Full TimeEducation
Level: Associates Degree
Salary Range: $16.08 - $26.13 Hourly

Travel Percentage: Negligible
Job Shift: Day
Job Category: Healthcare and Social AssistancePOSITION SUMMARY:
Assists patients referred through the Purchased and Referred Care (PRC) process to external providers to ensure medical services are received in accordance with PRC Guidelines.
ESSENTIAL FUNCTIONS:
- Coordinates  PRC referrals between patients, medical staff, and administrative staff;
- Obtains prior authorization from the patient’s primary care provider (PCP) before the patient is referred to a specialist;
- Obtains medical records or progress notes that support the internal/external PRC referral;
- Enters referral data into the electronic health records system to generate new PRC referrals;
- Assists patients with scheduling appointments to outside healthcare providers;
- Responsible for coordinating all internal/external PRC referrals to ensure continuity of care;
- Works closely with the RN Case Manager and Patient Benefit Coordinator to assist and advocate on behalf of the patient;
- Compiles statistical data for reporting purposes;
- Verifies PRC eligibility utilizing the RPMS and provides authorization to medical providers;
- Prepares and occasionally presents referred specialty cases for the PRC Committee;
- Notifies patient and provider if specialty care services are approved or denied by the PRC committee;
- Participates in Emergency Preparedness;
- Other Position related duties as assigned.

QualificationsMINIMUM REQUIREMENTS:
Associate degree or equivalent college credits or certificate from technical school related to health delivery or health education; One year experience working in a healthcare setting (experience with insurance verification and prior authorization is preferred, but not required); Must possess valid Texas Driver License and be insurable; Must be able to successfully pass a post-offer drug screen and criminal history background check.
KNOWLEDGE, SKILLS, AND ABILITIES:
Ability to communicate with others, including demonstrating active listening skills; Must possess excellent communication and time management skills; Must be able to read and write proficiently and interpret medical forms; knowledge of medical terminology; ability to occasionally travel; ability to maintain confidentiality at all times; ability to attain HIPPA training and certification; basic knowledge of EHR and RPMS; Must have knowledge of administrative and clerical procedures. Must have a working knowledge of Microsoft Office applications such as Word, Excel, PowerPoint, Access, and Outlook; Knowledge of principles and processes for providing excellent customer service; Problem-solving skills;  Ability to use technology including the use of laptops, smartphones and, internet/online application systems; Ability to work independently and as part of a team; Displays empathy, respect, and understanding of community values and members. Ability to organize information, events, and program activities.
PHYSICAL REQUIREMENTS:
While performing the essential functions of this position, the employee is frequently required to sit, talk, walk, stand and hear. The employee works indoor and outside in adverse weather.  The employee is occasionally required to reach with hands and arms. The employee is occasionally required to lift up 50 pounds. The vision requirements include; close vision, peripheral vision and ability to adjust focus.
This description is a summary of principle responsibilities and is not intended to include all duties which may be assigned.