Purchased and Referred Care Supervisor

Kenaitze Indian Tribe • Kenai, AK 99611

Posted 2 weeks ago

Job Description

Purchased and Referred Care (PRC) Supervisor

Dept./Program: Primary Care

Division: Health Systems

Reports To: Primary Care Director

Supervises: Purchased and Referred Care Technician

Employment Status: Full Time

FLSA Status: Exempt

Schedule: 40 hours/week

Preference: TERO Ordinance 2017-01, P.L. 93-638

Job Summary

The Purchased and Referred Care (PRC) Supervisor manages all functions associated with the administration of the purchased and referred care program, which include, provide support and supervision of the PRC staff, ensure compliance with PRC regulations, develop and implement PRC policies and procedures to optimize the effectiveness and efficiency of the PRC program.

Essential Functions

* Develops, coordinates and integrates the operations of the PRC program in accordance with approved policies and procedures pertinent to the administration and management of the PRC program.

* Supervise, train and mentor PRC support staff.

* Facilitate the development and education on all written PRC policies and procedures to all applicable healthcare staff and un'inas.

* Partners with Health System Administrators and provides technical assistance involving un'ina referrals for Medical, Dental, OB-GYN, Physical Therapy, and Vision Services.

* Integrates with Primary Care, Dental, Behavioral Health, Wellness and Optometry to optimize the referral procedure in accordance to the PRC payments criteria.

* Oversees and approves financial processing of PRC obligations. Ensures that Medicare-like Rates (MLR) are applied to applicable claims and un'inas meet the eligibility and referral requirements for PRC.

* Coordinates with Family Health Resources, Registration, and Care Team staff to establish a process for ensuring un'inas register for alternative resources and PRC is the payor of last resort.

* Monitors and facilitates PRC contracts with external preferred providers. Ensures all providers, support staff, and preferred providers are informed of PRC payment criteria with respect to the Tribe's PRC eligibility criteria and referral process.

* Reviews and analyzes PRC data to determine trends; communicates and reports trends to Health Leadership to provide direction regarding the improvement in un'ina care.

* Analyzes, develops, and implements annual budget for the PRC in coordination with Tribal leadership.

* Recommends updates to PRC policies and procedures based on the latest changes in regulations and best practices that affect the program.

It is the intent of this job description to highlight the essential functions of the position; however, it is not an all-inclusive list. The incumbent may be called upon and required to follow or perform other duties and tasks requested by his/her supervisor, consistent with the purpose of the position, department and/or the Kenaitze Indian Tribe's objectives.

Working Conditions

Lifting Requirements

Sedentary work Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

Physical Requirements

Stand or Sit (Stationary position)

Use hands/fingers to handle or feel (Operate, Activate, Use, Prepare, Inspect, Place, Detect, Position)

Stoop, kneel, crouch or crawl (Position self (to), Move)

Talk/hear (Communicate, Detect, Converse with, Discern, Convey, Express oneself, Exchange information)

See (Detect, Determine, Perceive, Identify, Recognize, Judge, Observe, Inspect, Estimate, Assess)

Pushing or Pulling

Repetitive Motion

Hazards and Atmospheric Conditions

Biohazards

OSHA Categories

Category II Normal routine involves no exposure to blood, body fluid or tissue, but exposure or potential for exposure may occur

Equipment and Tools

List Equipment used for job: computer, copier, fax, scanner, and other office equipment.

Drives KIT or Personal Vehicle: Personal

Travel

Local

Comments: Travel may be offered for training. Travel between tribal facilities may be required.

Qualifications

Education

* Bachelor's degree in Business Administration, Healthcare Administration or related field.

Experience

* Two years' experience in overseeing the administrative, operations, and financial functions of a healthcare organization/facility.

License/Certification

* Valid Alaska driver license and must remain insurable under the Tribe's policy.

Special Skills

* Knowledge of Purchased and Referred Care federal guidelines.

* Knowledge of how to operate office equipment such as computer, calculator, printer, fax etc.

* Demonstrated skills in providing excellent services to customers.

* Demonstrated skills in verbal communication and listening.

* Ability to cooperate with other staff members both within and outside department.

* Always exhibits traits of courtesy, caring, helpfulness, and respect.

* Conducts self in a service-oriented manner that is attentive, pleasant, respectful and kind when dealing with customers, visitors, public, employees, and others.

* Ability to be a team player.

* Excellent analytical thinking skills, ability to be organized, and detail oriented.

* Displays a high degree of professionalism.

Preferred

* Knowledge and experience working with Alaska Native/American Indian people.

* Knowledge and experience working within the Alaska Native health system.

* Knowledge of medical billing procedures and claims submission process.

* Knowledge and understanding of insurance processes.

* Knowledge of basic medical and coding terminology.

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