PRC Care Coordinator — Claims & Referrals

Great Plains Tribal Health; Rapid City (SD); On-site; USD 42,000 - 66,000; Full time

Job summary

Oyate Health Center seeks a Purchase Referred Care Coordinator to initiate, track, and process payer-of-last-resort insurance claims. You will manage CHS referrals, eligibility checks, and coordination with outside providers and clients.

Responsibilities include maintaining CHS files, preparing referrals for medical/dental review, and ensuring timely claim submission while complying with HIPAA and UIHS CHS guidelines. Weekly committee participation is expected.

Qualifications

• High school diploma or equivalent and 3 years of administrative support experience.
• Experience in Purchased Referred Care preferred to understand major duties.
• Ability to pass criminal background check and pre-employment drug screen.

Responsibilities

• Initiate, track, and process PRC payer-of-last-resort health insurance claims per UIHS CHS guidelines.
• Maintain PRC files and determine eligibility and referrals to alternate resources.
• Coordinate with outside providers and clients to schedule appointments and create purchase orders.
• Communicate with clients, providers, and UIHS to clarify referrals and claim status.
• Attend weekly Managed Care Committee meetings and ensure HIPAA compliance.

Skills

Administrative support

Purchased Referred Care knowledge

HIPAA compliance

Customer service

Education

High school diploma or equivalent

Tools

Microsoft Office

Contract Health Services system

Job description

Oyate Health Center seeks a Purchase Referred Care Coordinator to initiate, track, and process payer-of-last-resort insurance claims. You will manage CHS referrals, eligibility checks, and coordination with outside providers and clients.

Responsibilities include maintaining CHS files, preparing referrals for medical/dental review, and ensuring timely claim submission while complying with HIPAA and UIHS CHS guidelines. Weekly committee participation is expected.