Purchase And Referred Care Coordinator

The Purchased and Referred Care Coordinator ensures all eligible Snoqualmie Indian Tribal members have access to medical, dental, and vision health care as provided by Indian Health Service and the Snoqualmie Indian Tribe's PRC Program. Assist Tribal members to complete necessary applications, help obtain alternative resources, provide referrals, and collect required documentation for payment.
Essential Duties:

• Administers purchased and Referred Care to eligible clients according to federal rules and regulations while adhering to annual fixed funding.
• Assumes dual responsibility for processing routine and complex health claims while providing excellent customer service for assigned accounts.
• Assumes primary responsibility for processing routine and complex health claims on multiple assigned accounts.
• Act as a resource for clients, community members, and other Health and Wellness department staff.
• Build, establish and maintain excellent working relationships with all internal and external sources.
• Ensure all IHS eligibility criteria requirements are met before clients receive services.
• Ensure all other alternate services have been exhausted for clients, maintain current knowledge of all other alternative resources, and give accurate information on how the client may obtain available resources.
• Follow rules, guidelines, and procedures to solve problems. Work as a team member and handle difficult situations in a calm and professional manner.
• Determine level of medical services required within IHS/Tribal priorities. Inform clients of services not covered in a professional manner.
• Perform routine and complex administrative and clerical tasks accurately under time constraints and high pressure environment to maintain current procedures, medical claim processing resources, and updated PRC RPMS claim systems data.
• Conduct in-depth research to resolve medical claims issues and compose detailed and customized communications as needed.
• Assist patients and other Health and Wellness staff with questions on processing medical claims, direct questions and issues to appropriate persons as needed.
• Independently process routine medical and complex health claims of all types in line with all private, state, and federal plans with primary client service responsibility.

Additional Duties:

• Assist other PRC staff with claims as needed to minimize backlog.
• Work closely with and serve as back up for other PRC Coordinators including their duties or responsibilities and on call and phone coverage.
• The Tribe values its commitment to community service and the well-being of its members. In recognition of this, each employee may be expected to perform duties from time to time which may not be related to their regular responsibilities.
• Other duties as assigned.

Requirements

• Ability to accept responsibility and account for his/her actions.
• Ability to perform work accurately and thoroughly.
• Ability to actively attend to, convey, and understand the comments and questions of others.
• Ability to take care of the customers' needs while following company procedures.
• Ability to be culturally sensitive.
• Ability to find a solution for or to deal proactively with work-related problems.
• Ability to be internally inspired to perform a task to the best of one's ability using his or her own drive or initiative.
• Communicate with tact and discretion while maintaining the highest level of confidentiality in line with HIPAA and related regulations and policies.
• Proficiency with Microsoft Office Programs required.
• Strong organizational skills, accuracy, and attention to detail.
• Excellent written and verbal communication skills.
• Demonstrated ability to communicate effectively with diverse populations.
• Familiar with medical terminology and with ICD-10, CPT and HCPC Codes.

Education & Experience:
Education Required:

• High School Diploma or equivalent

Education Preferred:

• Associate Degree from an accredited university in accounting, business, public health administration or related field

Experience:

• Two or more years' related work experience preferred. Experience with IHS tribal health programs preferred.
• Experience with private insurance, Medicaid, and Medicare programs preferred.
• Electronic health records/RPMS experience preferred.

Certifications/Licenses:

• HIPAA certification required within 45 days of employment. Must maintain HIPAA certification throughout duration of employment.

Other Requirements:

• Must be able to pass a thorough pre-employment background investigation.
• Must agree to be subject to the Tribe's Controlled Substance and Alcohol Testing Policy to include pre-employment screening.

Tribal Preference:
The Snoqualmie Indian Tribe follows the Tribal Hiring Preference as outlined in tribal policies, including the Tribal Employment Rights Ordinance (TERO). TERO sets forth certain hiring preferences for qualified individuals who are enrolled in a federally recognized Indian tribe, as well as, in some cases, preference for certain family members of those individuals.
Additional Information:

• Hourly, compensation will be determined based on experience and starts at $24.14 per hour.
• This position is a regular full-time position and employment is at will.

Location:

• Snoqualmie, WA

Benefits:

• First of the month following date of hire - competitive medical, dental, vision, life, and disability insurance benefits for all regular full-time employees.
• After 90 days - 401k retirement plan with employer matching contributions up to 4%.
• Paid Holidays - Up to 18 paid holidays are offered every calendar year, which includes the workdays between Christmas Eve and New Year's Day.
• Paid Time Off - Employees accrue 12+ days sick and vacation leave respectively. Increases based on years of service.

Additional Perks:

• Additional time off opportunities available including bereavement, military, parental and jury duty.
• Childcare subsidy for children enrolled full-time in the Snoqualmie Tribe Child Development Center.
• Employee discounts at Snoqualmie Casino (tickets/events, gift shop and restaurants), Salish Lodge & Spa (rooms, spa & dining) and Crescent Market (gas discount card).
• Third party perks include movie tickets, theme parks, shows and attractions & more.
• Employee assistance plans.

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