Administrative Medical Assistant - PRC

PLEASE NOTE - This position may require temporarily relocation to other TONHC Fa cilities : Sells Hospital, Santa Rosa Health Center, San Simon Health Center, and San Xavier Health Center.

Position Summary :

The incumbent is responsible for administering the Purchased / Referred Care (PRC) program. Responsibilities include allocating PRC funds and alternate healthcare resources to provide complete comprehensive health services for Tohono O'odham Nation Health Care's user population.

Scope of Work :

This position is located within Tohono O'odham Nation Health Care's Purchased Referred Care (PRC) Branch or Administrative Office. It may be situated organizationally and duty stationed at any TONHC facilities : Sells Hospital, Santa Rosa Health Center, San Simon Health Center, and San Xavier Health Center.

Essential Duties and Responsibilities : (Depending on the area of assignment, an incumbent may not be required to perform some of the duties listed below) :

• Maintains collaborative measures with the clinical teams to assure initial and process follow-up patient referrals according to the current PRC mapping process for the health care facility.
• Responsible for determining patient eligibility, scope, and priority for the PRC program.
• Responsible for entering necessary referrals into the RCIS system.
• Assists patients in the scheduling of referred appointments.
• Provide education to patients on special instructions for referred visits.
• Follows up on referred visits scheduled to ensure the referring facility receives the visit records.
• Follows up with patients after referred visits to coordinate follow-up primary care visits as necessary.
• Respond to PRC inquiries and requests for PRC assistance from the clinic staff and patients.
• Respond to inquiries and requests within the TONHC Healthcare facilities, including medical, social service, dental, and private sector health resources regarding PRC referral status.
• Responsible for implementing decisions made for the provision or denial of services.
• Responsible for effective and maximum utilization of PRC funds and maintaining a follow-up system that will assure adequate funds are set aside for all authorized referrals, emergency notifications, and follow-up care referrals per policy and clinic mapping process.
• Assures obligation of all funds by the end of the funding period.
• Assures the cancellation of all unused obligations on a timely basis.
• Assures all outstanding authorizations over 30 days old are valid.
• Assures authorizations are only processed when funds are available.
• Assures transactions affecting funds are promptly processed; this includes obligations, disbursements, cancellations, reconciliation, and recording allocations.
• Assures effective communication with fiscal intermediaries and Finance, responding to all pending claims.
• Maintains the Nation's commitment to registering for PRC funds for medical and dental services.
• Responsible for maintaining a register for all requests for additional funding.
• Compiles statistical and fiscal data reports necessary to determine funds required to meet the PRC program's needs.
• Prepare all PRC financial status reports, budget needs, forecasts, and other required PRC reports for the Hospital.
• Reconciles with Financial Management Reports and Fiscal Intermediary, keeping supervisor and Hospital and clinic staff advised on current fund status.
• Assist with reporting Catastrophic Health Emergency Fund (CHEF) cases. Works closely with PRC staff and medical officers to report, manage and monitor the high-cost cases funded through the CHEF program established by P.L. 100-173 Section 202.
• Responsible for keeping up-to-date pending and completed PRC patient files with a documented status of all written and verbal transactions.
• Performs periodic spot reviews and audits of completed authorization forms and other documents to ensure the consistent, correct use of allotment, object, sub-object, and sub-activity coding required.
• Works with Hospital and Clinic professional and para-professional staff, local providers, tribal health committees; serves as a representative at meetings to create and understand the PRC programs and promote consumer and provider satisfaction.
• Incumbent must know computer applications relating to the PRC Program, including the responsibility for key entering and verifying all PRC service authorization, payments, cancellations, and supplements.
• Responsible for adding, deleting, changing, and verifying information in both the patient file and vendor.
• Contribute to a team effort.
• Other duties as assigned.

Knowledge, Skills, and Abilities :

Minimum Qualifications :

Licenses, Certifications, Special Requirements :