PRC Technician – Referrals & Eligibility

County 10; Wyoming, Northern (OH, KY); Hybrid; USD 25,000 - 30,000; Full time

Job summary

County 10 seeks a PRC Technician to support the Purchased/Referred Care department in a fast-paced medical setting. You will perform clerical duties, verify eligibility, process referrals, and coordinate documentation for prior authorizations.

Responsibilities include data entry, communicating with patients and providers, maintaining confidentiality under HIPAA, and ensuring accurate patient profiles and documentation for referrals. Minimum 3 years of clerical experience preferred.

Qualifications

• High School diploma or GED.
• Minimum 3 years of clerical or receptionist experience in a medical or business setting.
• Experience with Electronic Health Records (EHR) preferred.
• Strong communication, organizational, and computer skills.
• Ability to manage complex situations, apply critical thinking, and work independently.
• Culturally sensitive to Native American populations.
• Self-motivated and able to prioritize tasks effectively.

Responsibilities

• Request, collect, and review medical documents from providers.
• Verify primary insurance, alternate resources, and contract health eligibility.
• Initiate and distribute medical authorizations; determine patient eligibility for direct and contract services.
• Maintain tracking systems for high-cost cases and CHEF fund submissions.
• Organize and maintain denial correspondence files with complete documentation.
• Conduct patient interviews to verify residence and eligibility.
• Participate in CHS review committee meetings.
• Manage and update patient profiles, consents, and documentation required for referrals and prior authorizations.
• Respond to PRC inquiries by phone, correspondence, or in person.
• Provide information regarding PRC services to patients and community members.
• Enter and maintain accurate client data and organized files.
• Uphold strict confidentiality and compliance with HIPAA regulations.
• Perform other duties as assigned.

Skills

Communication skills

Organizational skills

Computer skills

Education

High School diploma or GED

Tools

EHR software

Job description

County 10 seeks a PRC Technician to support the Purchased/Referred Care department in a fast-paced medical setting. You will perform clerical duties, verify eligibility, process referrals, and coordinate documentation for prior authorizations.

Responsibilities include data entry, communicating with patients and providers, maintaining confidentiality under HIPAA, and ensuring accurate patient profiles and documentation for referrals. Minimum 3 years of clerical experience preferred.