PRC Fiscal Officer

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Description

The primary function of this position is to maintain the fiscal integrity of the Purchased Referred Care (PRC) program through strict observance of Clinic PRC policy and to ensure timely processing of claims for payment.

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Type

Full-Time

Department

Tribal Health Clinic

Supervisor

Business Office Manager

Salary

Level 14-0 $15.37 to Level 16-0 $16.94 F/T 40hrs/wk

Duties

  • Prepares PRC claims and Purchase Orders (PO) to Tribal Finance for payment.
  • Reviews medical claims and insurance benefit statements for accuracy and communicates with vendors/insurers.
  • Re-prices medical claims according to the Medicare/Medicaid/MediCal fee schedule.
  • Reconcile checks against claims paid and prepare for mailing.
  • Maintains accurate and complete patient claim files.
  • Documents each step of referral and payment process in clinic’s electronic medical records system.
  • Complies with the Clinic’s PRC priority level, policies and procedures.
  • Notifies patients of PRC denials and processes patient appeals for review by PRC committee.
  • Negotiates beneficial rate quote agreements with hospitals and specialty providers.
  • Maintains current files of all agreements.
  • Acts as primary point of contact for PRC providers and PRC patients.
  • Mediates with third party insurance carriers for prompt payment.
  • Adheres to strict standards of confidentiality and maintains compliance with HIPAA regulations.
  • Performs other duties as assigned.

Qualifications

  • An Associate’s degree in Health Care Administration or Business Administration OR a minimum of three years’ demonstrated experience in accounts payable, insurance billing, or medical office financial management required.
  • Knowledge of PRC rules and regulations is preferred.
  • Proficiency in medical terminology and medical coding is strongly preferred.
  • Excellent computer word processing, data entry and spread sheet skills.
  • Able to adapt to increased reliance on electronic medical records and technology.
  • Demonstrate excellent verbal, written communication and customer service skills.
  • Detail oriented with solid organizational and filing skills required.
  • Be a team player and willing to cross train other staff or be cross trained in other duties.
  • Able to lift 40lbs or more.
  • Possess a valid Nevada Driver’s License and be insurable.
  • Pass pre-employment drug screen and complete background investigation.

Application Deadline