Purchase/Referred Care PRC Coordinator

Salary: $49,043. 00 - $64,983. 00 Annually
Location : Scottsdale, AZ
Job Type: Full-Time
Job Number: 100940-250128
Department: Health & Human Services
Opening Date: 01/28/2025
Closing Date: 2/11/2025 11:59 PM Arizona

Definition
Under clinical supervision of the Clinic Administrator, the Purchase Referred Care (PRC) Coordinator maintains a centralized medical and dental referral system and will be responsible for coordinating all patient referrals and follow ups, working closely with the medical staff and external providers. The PRC Coordinator serves as an advocate for patients being referred for outside services. This job class is treated as FLSA Non-exempt. Essential Functions: Essential functions may vary among positions and may include the following tasks and other characteristics. This list of tasks is ILLUSTRATIVE ONLY and is not intended to be comprehensive list of tasks performed by all positions in this classification.
Examples of Tasks

1. Coordinates referrals and appointments with medical specialists, including determining patient's health care payment and eligibility resources; but not limited to: obtaining all insurance pre-authorizations necessary for the referral; sending all medical notes, demographics, and billing information to the outside vendor; tracking the patient appointments to completion; arranging for transportation if needed; following up with the outside vendors to ensure patient records are received and ensures patient has proper follow-up until medical care is complete.
2. Maintains compliance with Indian Health Services Purchased/Referred Care program regulations and clinic program policies and procedures to include the maximum utilization of alternate resources.
3. Works closely with business office, clinic providers/Medical Review Team to ensure that all external medical/dental professional referrals are medically appropriate and within medical and dental priority.
4. Makes appointments and issues purchase orders (PO) for patients being referred outside of the clinic; coordinates with Purchased/Referred Care, the Business Office and the Benefits Coordinator determine PRC eligibility and payment of POs.
5. Maintains accurate and current electronic record keeping system for PRC program.
6. Participates in QI health department meetings, program planning, evaluations & improvement strategies to minimize problems and optimize operation efficiency.
7. Miscellaneous: Performs other job-related duties as assigned by the supervisor.

• Knowledge of the history, customs, culture and traditions 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 rules and procedures related to medical service eligibility.
• Knowledge of Salt River Clinic service eligibility requirement.
• Knowledge of whether documented proof for service meets clinic requirements.
• 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 internal organizational structure and use of health records related to HIPPA and associated privacy and confidential requirements.
• Knowledge of eligibility criteria in the use of alternate resources.

• Skill in providing information on Medicare/Medicaid, SSA County DES, DSS offices and tribal programs, contract health and other related agencies policies and procedures.
• Skill in evaluating the extent of customers' knowledge of the options and choices open to them.
• Skill in applying applicable rules and procedures in relationship to medical eligibility.
• Skill in specialized medical terminology and interpretation of terms.
• Skill in interviewing patients thoroughly in order to determine eligibility for alternate funding.
• Skill with personal computer including MS Office and other related software and various office equipment.
• Skill communicating orally and in writing to gain the confidence of patients.

• Ability to answer intelligently, tactfully and accurately the question(s) raised by patients.
• Ability to handle confidential and sensitive information.
• Ability to communicate effectively on the telephone or in person.
• Ability to exercise good judgement in calls or personal contact with patients.

• Education & Experience: High School or GED equivalent required and two (2) years' experience in customer service and/or related clinical environment. An Associate's Degree or related healthcare certification preferred.
• 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.

• 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".