PRC Claims & Referrals Specialist

Uihs; Arcata, Northern (CA, KY); Vor Ort; USD 37.000 - 47.000; Vollzeit

Zusammenfassung

United Indian Health Services (UIHS) seeks a Purchased Referred Care Technician to manage PRC referrals in Arcata, CA. You will initiate, track, and process referrals and ensure eligibility per PRC guidelines.

The role involves coordination with providers, managed care, and case tracking through to payment. Responsibilities include preparing referrals for medical and dental review, communicating status to clients and agencies, and reporting on claims activity.

Qualifikationen

• High school diploma or GED required for Level I/II/III.
• For Level I: 0-1 years of clerical office or related experience showing ability to learn required duties.
• For Level II: 1-2 years of PRC or related experience, ability to work independently and in a team, healthcare setting preferred.
• For Level III: 3+ years of PRC or related experience, ability to train Level I/II, healthcare setting experience.

Aufgaben

• Initiate, track, and process PRC referrals per UIHS guidelines.
• Determine PRC eligibility and refer to Alternate Resources when eligible.
• Communicate with outside providers, agencies, and clients regarding referrals, status, and payments.
• Prepare and submit referrals for medical and dental reviews.
• Track cases through appointment, eligibility, and final payment processing.
• Attend PRC meetings at Board and Administrative levels.
• Commit to culturally sensitive services for American Indians.

Ausbildung

Level I

Level II

Level III

Jobbeschreibung

United Indian Health Services (UIHS) seeks a Purchased Referred Care Technician to manage PRC referrals in Arcata, CA. You will initiate, track, and process referrals and ensure eligibility per PRC guidelines.

The role involves coordination with providers, managed care, and case tracking through to payment. Responsibilities include preparing referrals for medical and dental review, communicating status to clients and agencies, and reporting on claims activity.