Purchased Referred Care Supervisor

Salt-River-Pima--maricopa-Indian-Community-; Scottsdale (AZ); On-site; USD 70,000 - 100,000; Full time

Job summary

The Salt River Pima- Maricopa Indian Community's Purchased Referred Care Department seeks a dedicated supervisor to oversee daily operations and provide leadership for PRC Referral Coordinators. You will ensure secure handling of patient referrals, monitor workflow, and support policy interpretation and program development.

Responsibilities include staff coaching, performance reviews, coordinating with providers and payors, and preparing reports to support efficient PRC funding and service

Qualifications

• 4-year college degree preferred; high school diploma or GED required.
• Minimum 3 years leading staff in a health or PRC setting.
• Experience with health records, referrals and scheduling is preferred.

Responsibilities

• Direct supervision and coaching of PRC Referral Coordinators.
• Maintain security and confidentiality of patient information.
• Prepare monthly reports and monitor workflow, productivity and service quality.
• Ensure compliance with PRC policies and SOPs.
• Collaborate with contracts, health providers and payors.

Skills

Staff supervision

Policy interpretation

Data analysis

Communication skills

Training & development

Regulatory compliance

Education

High school diploma or GED; 4-year college degree preferred

Tools

RPMS packages RCIS CHSMIS EHR BCBS FI

AHCCS online

Novitas online

Job description

Under general administrative program supervision of the Purchased Referred Care Manager. This position oversees the daily operations and supervises the Referral Coordinators of the Salt River Purchased Referred Care Department, including coordination and monitoring all PRC referrals, serves as an advisor on the PRC program on policy implementation and interpretation, program planning, program development, administration, management, operation, and evaluation of a comprehensive PRC program. This job class is treated as FLSA-Exempt.

Essential Functions:

• Workflow, Direction and Supervision: Direct supervision of PRC Referral Coordinators, training, and guidance in the maintenance/safekeeping of patient medical referrals while maintaining security, confidentiality, accuracy, completeness, and accessibility of health information.
  • Schedules and supervises the work of assigned staff to achieve the defined business goals and to ensure smooth workflow in the department.
  • Coordinates team activities and the staff to workload ratios to accomplish the most effective use of resources.
  • Sets work goals for team members and monitors measurable outcomes in accuracy, timeliness, productivity and service quality.
  • Provides leadership, work goals and coaching for staff. Participates in selecting hires and trains staff for assigned duties
  • Develops and promotes strong inter-departmental teamwork to meet the needs of the patients and providers and drives decision-making and other actions. Provides training and guidance to new PRC staff members with the PRC workflow
  • Conducts performance reviews, coaching/disciplinary action and termination of assigned staff following the Community’s personnel policies.
  • Uses advanced business and software skills for creating documents, letters, spreadsheets, reports, and presentations. Identifies training needs and provides and/or arranges for needed training.
  • Approves leave requests, provides advice, counsel or instructions to employees on both work and administrative matters.
  • Identifies and implements changes regarding policy, productivity and quality measures, and assures that staff performance improvements related to work-flow efficiencies and operations.
  • Provide support and technical assistance to the PRC Referral Coordinators on matters involving referrals for medical, surgical, dental, hospital and clinical services to all eligible beneficiaries.
  • Performs liaison functions with contract health providers, state and local agencies; and monitors/reports status of PRC activities and funds.
  • Establish community and payor relationships while maintaining compliance with payment and financial analysis to ensure effective department functions.
  • Prepares analytical data, staff reports and memoranda which reflect utilization of PRC funding resources.
  • Maintain up-to-date knowledge on regulatory changes for effective management of the health record system and PRC program and guidelines
  • Develops, recommends and implements changes to the PRC policies, procedures and Standard Operating Procedure (SOP)
  • Ability to demonstrate Customer Service/Conflict Resolution Experience.
  • Performs other duties as assigned.
• Measurement and Evaluation of Performance:
  • Prepares monthly statistical reports on data quality, individual PRC Referral Coordinator assigned patient referrals and assures the issuance of Purchase Orders/claim payments to providers are within specified time limits.
• Patient Eligibility/Interaction: Ensures the PRC Referral Coordinators are adhering to the following;
  • Knowledge of alternate resources: state Medicaid, Medicare, Medicare Advantage Plans, Private Insurances, Tribal Health Insurance,
  • Screens all cases for PRC eligibility
  • Ensures all eligibility factors are met prior to obligating PRC funds
  • Refers patients to the Benefit Coordinators to apply for alternate resources when they are potentially eligible and documents efforts.
• Performs other related duties as assigned.

Knowledge, Skills, Abilities, and Other Characteristics:

• Knowledge of the culture, customs, traditions, history and government of the Salt River Pima- Maricopa Indian Community.
• Knowledge of the federal Freedom of Information Act, Privacy Act and HIPAA laws as they pertain to the SRPMIC work environment.
• Knowledge of PRC programs and regulations
• Knowledge of RPMS packages: RCIS, CHSMIS, EHR, Patient Registration and BCBS Fiscal Intermediary (FI)
• Knowledge of AHCCS online, Novitas online and other insurance eligibility online eligibility systems.
• Knowledge of various clinical systems, walk-ins and appointments to avoid unnecessary delay and/or confusion on the part of patient.
• Knowledge of various medical services offered by the clinic.
• Knowledge of patient business functions and processes to augment Third Party Billing activities and routines.
• Knowledge of CPT, ICD-10, HCPCS and dental coding and billing activities. Ability to understand and comply with the requirements of the Privacy Act, HIPAA, and maintaining confidentiality of patient information
• Knowledge of alternate resources: State Medicaid (AHCCCS), Medicare, Medicare Advantage Plans, Private insurance, Tribal Self-Insured insurance plans and other related programs.
• Knowledge of administrative/clerical procedures and systems (e.g. equipment, file management, software programs, etc.)
• Ability to manage employees in a high-stress environment.
• Fosters teamwork and a positive working relationship with others
• Ability to use excellent communication skills, both verbally and in writing, to deal effectively with all levels of co-workers
• Possession of high ethical standards. Ability to work independently, multi-task, prioritize and manage time to strict deadlines
• Reliable and dependable; adheres to work schedule and SRPMIC attendance policies.
• Knowledge of medical terminology and medical care practices and procedures
• Knowledge of CPT, ICD-10 and HCPCS coding

Education:

High school diploma or GED required; 4-year college degree preferred.

Experience:

Minimum of 3 years’ full-time work experience managing and leading staff.

• Experience working with health record, patient referrals and scheduling preferred
• 2 years’ experience (minimum) with employee performance management (e.g., evaluations, technical assistance, corrective action, etc.)
• 2 years’ experience in medical administrative support, medical billing and/or Purchase Referred care role

Equivalency:

Any equivalent combination of education and/or experience that would allow the candidate to satisfactorily perform the duties of this position, will be considered.

Underfill Eligibility:

An enrolled Community Member whom closely qualifies for the minimum qualifications for a position may be considered for employment under SRPMIC Policy 2-19, Underfill.

Special Requirements –

May be required to work beyond normal work hours including nights, weekends and holidays.

• Employees in, and applicants applying for, jobs providing direct services to children are subject to the “Community Code of Ordinances”, Chapter 11, “Minors”, Article X. “Investigation of Persons Working With Children”.
• Ensures all patient information is kept confidential and complies with Health Insurance Portability and Accountability Act (HIPAA) regulations and SRPMIC HHS policies and procedures.

Prior to hire as an employee, applicants will be subject to drug and alcohol testing. Will be required to pass a pre-employment background/fingerprint check.

SRPMIC is an Equal Opportunity/Affirmative Action Employer Preference will be given to a qualified: Community Member Veteran, Community Member, Spouse of Community Member, qualified Native American, and then other qualified candidate.

Preference Requirements:

In order to obtain preference, the following is required:

• 1) Qualified Community Member Veteran (DD-214) will be required at the time of application submission
• 2) Qualified Community Member (must provide Tribal I.D at time of application submission)
• 3) Spouse of a Community Member (Marriage License/certificate and spouse Tribal ID or CIB is required at time of application submission)
• 4) Native American (Tribal ID or CIB required at time of application submission)

Documents may be submitted by one of the following methods:

• 1) attach to application
• 2) fax [phone]
• 3) mail or hand deliver to Human Resources
• 4) email to [e-mail]

Documentation must be received by position closing date.