CHS/PRC Claims Specialist
for section headings. Use - for any list of duties/requirements/benefits, and
for prose.
We must preserve all substantive information, not invent or summarize away detail. Remove boilerplate: the first paragraph about NSORNA etc is likely required? It's about sex offender registration and notification act, which is a requirement. It's substantive? It's a legal requirement for the position. Should we keep? It's not boilerplate; it's a specific requirement. So we should include it maybe under "About the role" or as a preamble. The instruction: "Use
for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." So we can have sections like About the role, Responsibilities, Requirements, Qualifications, Skills. We need to decide mapping.
We have "General Summary" which could be About the role. Then "Primary Responsibilities" and "Job Duties" could be Responsibilities. Then "Safety" and "Communication" could be part of Responsibilities or separate sections like Skills? Might be better to keep them as sub-sections under Responsibilities? But we need to follow instruction: include a section ONLY when posting has real, specific content for it. We can create sections: About the role (General Summary), Responsibilities (Primary Responsibilities + Job Duties + Safety + Communication), Requirements (Minimum Qualifications), Qualifications (Preferred Qualifications). Skills maybe not separate.
We must not repeat job title as heading. No Job ID.
We need to use - for any list of duties/requirements/benefits. So for responsibilities we should list each duty as
- . For qualifications we list each as
- . For safety and communication maybe also list.
We must preserve all substantive information: need to include each bullet point from the text.
Let's extract content.
First paragraph: "Please note: NSORNA Nisqually's Sex Offender Registration and Notification Act requires all individuals who have ever been convicted of a sex offense to register with our Public Safety Department. This is true whether or not you have to register with another jurisdiction. This position has regular contact with or control over Indian Children and Vulnerable Adults. In compliance with Federal Law, this position will not be filled by an applicant with any felonious offense or any of two or more misdemeanor offenses under Federal, State, or Tribal law involving crimes of violence; sexual assault, molestation, exploitation, contact, or prostitution; crimes against persons; or offenses committed against children."
That's a requirement/legal note. Could go under About the role or Requirements. Probably under Requirements (legal). We'll include as a
maybe.
Then "General Summary Working with a motivated Business Office Staff focused on providing access and support of specialty referred care from a Health and Wellness Center environment, by way of coordination of care, management of benefits, approvals of services based on IHS eligibility guidelines, to provide the best customer service and assistance to the population that we serve. Our responsibility is to assure prompt, accurate financial processing, and reporting for our financial obligations."
That's prose.
Then "Primary Responsibilities Primary responsibilities are the basic job duties that an employee must be able to perform. This list of responsibilities is intended to be representative of the duties performed within this classification. The omission of a function does not preclude management from assigning duties not listed if such duties relate to the position."
That's intro prose before list.
Then list of Job Duties (many sentences). We need to turn each sentence into
- . Let's extract each duty:
- Ensure that all Indian Health Contract Health Service requirements are met for all eligible clients/patients and assists in all necessary daily operations of the CHS program.
- Administer contracted health care to eligible clients/patients according to the IHS federal guidelines, and the programs Policy & procedures, as well as federal rules/regulations based on annual funding.
- Responsible for assuming dual responsibility for processing routine and complex health claims as well as providing customer service to both patients and providers.
- Serve as a resource for clients/community members and other Nisqually Tribal Health & Wellness Center staff.
- Conduct a majority of their workday with face to face and phone contact with PRC/CHS eligible clients issuing authorizations for medical care.
- Assists in assuring patient eligibility meets the IHS/PRC guidelines.
- Verifying all alternative medical insurance resources are utilized prior to providing PRC services.
- Generating Purchase Order numbers (PO) through the current PRC operating system, for patients requesting via telephone or in person.
- Matching Explanation of Benefits (EOB) to existing Purchase Orders (PO)
- Verify and document the status of each individual existing Purchase Orders (PO), for completion of the billing process, and to assure payments are made in a timely manner.
- Work with off-site Specialty Providers inquiring about referrals, and services related to physician visits, laboratories, pharmacies, dental providers, and patients via mail or in person.
- Works daily with invoicing of PRC/CHS claims, and the posting of payments.
- Provide answers to referring physicians, and those responsible for their billing, when inquiring about payment status.
- Open and sort incoming correspondence.
- Participates in seminars and meetings that relate to Purchase Referred Care/Contract Health Services.
- Filing and other common clerical duties.
Then "Safety Adheres to safety policies and procedures within the Nisqually Health & Wellness program.Reports inappropriate incidents by filing incident reports and forwarding the report to their immediate supervisor.Respond to emergencies in a calm and professional manner and report to designated area and or person in case of an emergency."
We can make each sentence as
- under Safety maybe.
Then "Communication Represents the Nisqually Tribal Health & Wellness Center in a positive and professional manner when interacting with patients and the community.Demonstrate positive interpersonal relations skills in dealing with staff, providers, and management.Consistently maintains confidentiality and follows HIPAA guidelines, on behalf of the patient and the organization.Participates in staff meetings."
Again each sentence as
- .
Then "Minimun Qualifications Education and Experience Graduation from high school or equivalent.Three years' experience in a Purchased Referred Care or Contract Health Service program or IHS program specific to Tribal health services.Three years' experience processing all types of health/dental claims.Two years in depth knowledge of all aspects of benefits & claims processing.Two years successful customer service background."
We need to split into list items.
- Graduation from high school or equivalent.
- Three years' experience in a Purchased Referred Care or Contract Health Service program or IHS program specific to Tribal health services.
- Three years' experience processing all types of health/dental claims.
- Two years in depth knowledge of all aspects of benefits & claims processing.
- Two years successful customer service background.
Then "Preferred Qualifications Experience in a Tribal PRC/CHS ProgramExperience in medical billing in both ambulatory and hospital settings.Experience and knowledge of state, federal and private insurances.A strong understanding and knowledge of private, state, and federal health insurance practices as it pertains to processing patient in-coming claims.Flexible, self-motivated, independent, detailed oriented and reliable.Experience in customer service.Knowledgeable in CPT and ICD-10 billing codes.Knowledge of medical terminology.Ability to communicate effectively both oral and written.Dependable and prompt."
Split:
- Experience in a Tribal PRC/CHS Program
- Experience in medical billing in both ambulatory and hospital settings.
- Experience and knowledge of state, federal and private insurances.
- A strong understanding and knowledge of private, state, and federal health insurance practices as it pertains to processing patient in-coming claims.
- Flexible, self-motivated, independent, detailed oriented and reliable.
- Experience in customer service.
- Knowledgeable in CPT and ICD-10 billing codes.
- Knowledge of medical terminology.
- Ability to communicate effectively both oral and written.
- Dependable and prompt.
Now we need to decide sections.
We could have:
About the role
General Summary ...
Responsibilities
- ... duties ...
... plus Safety and Communication items maybe also under Responsibilities? Could separate Safety and Communication as own sections but they are not typical headings list; but we could include them as sub-sections under Responsibilities? The instruction says use headings for sections like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. It doesn't forbid other headings, but we should prefer those. Safety and Communication could be considered part of Responsibilities or Skills. I'd include them under Responsibilities as additional items.
Thus Responsibilities section will contain all duties, safety, communication items.
Then Requirements section: include the legal note (NSORNA etc) plus Minimum Qualifications.
Then Qualifications section: Preferred Qualifications.
We should not create Skills section unless there is specific skills content; we have some skills in Preferred Qualifications but we can keep them there.
Now we need to ensure we don't repeat job title. No Job ID.
We need to output only HTML fragment.
Let's craft.
Start with About the role
Working with a motivated Business Office Staff focused on providing access and support of specialty referred care from a Health and Wellness Center environment, by way of coordination of care, management of benefits, approvals of services based on IHS eligibility guidelines, to provide the best customer service and assistance to the population that we serve. Our responsibility is to assure prompt, accurate financial processing, and reporting for our financial obligations.
Then maybe include the legal note as part of Requirements? Actually legal note is about eligibility; could be under Requirements. We'll put it there.
Now Responsibilities: Responsibilities
with each duty.
We need to include the intro sentence about Primary responsibilities? Could be a before list. But instruction: use
for prose. So we can have a
before the list: "Primary responsibilities are the basic job duties that an employee must be able to perform. This list of responsibilities is intended to be representative of the duties performed within this classification. The omission of a function does not preclude management from assigning duties not listed if such duties relate to the position."
Then
- ... each duty.
Then after duties we could add Safety and Communication items as
- as well, but maybe better to keep them under same list? Could add a
before safety: "Safety" then list. But we need headings for sections only if we have specific content. We could add
Safety
and Communication
but those are not in the example list but allowed? The instruction says use for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It doesn't forbid other headings, but we should prefer those. However we can still include Safety and Communication as sub-sections under Responsibilities using
headings? Might be okay to just include them as list items without separate heading.
I'll include them as list items under Responsibilities.
Now Requirements:
Requirements
Please note: NSORNA Nisqually's Sex Offender Registration and Notification Act requires all individuals who have ever been convicted of a sex offense to register with our Public Safety Department. This is true whether or not you have to register with another jurisdiction. This position has regular contact with or control over Indian Children and Vulnerable Adults. In compliance with Federal Law, this position will not be filled by an applicant with any fel
for prose. We must preserve all substantive information, not invent or summarize away detail. Remove boilerplate: the first paragraph about NSORNA etc is likely required? It's about sex offender registration and notification act, which is a requirement. It's substantive? It's a legal requirement for the position. Should we keep? It's not boilerplate; it's a specific requirement. So we should include it maybe under "About the role" or as a preamble. The instruction: "Use
for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." So we can have sections like About the role, Responsibilities, Requirements, Qualifications, Skills. We need to decide mapping.
We have "General Summary" which could be About the role. Then "Primary Responsibilities" and "Job Duties" could be Responsibilities. Then "Safety" and "Communication" could be part of Responsibilities or separate sections like Skills? Might be better to keep them as sub-sections under Responsibilities? But we need to follow instruction: include a section ONLY when posting has real, specific content for it. We can create sections: About the role (General Summary), Responsibilities (Primary Responsibilities + Job Duties + Safety + Communication), Requirements (Minimum Qualifications), Qualifications (Preferred Qualifications). Skills maybe not separate.
We must not repeat job title as heading. No Job ID.
We need to use - for any list of duties/requirements/benefits. So for responsibilities we should list each duty as
- . For qualifications we list each as
- . For safety and communication maybe also list.
We must preserve all substantive information: need to include each bullet point from the text.
Let's extract content.
First paragraph: "Please note: NSORNA Nisqually's Sex Offender Registration and Notification Act requires all individuals who have ever been convicted of a sex offense to register with our Public Safety Department. This is true whether or not you have to register with another jurisdiction. This position has regular contact with or control over Indian Children and Vulnerable Adults. In compliance with Federal Law, this position will not be filled by an applicant with any felonious offense or any of two or more misdemeanor offenses under Federal, State, or Tribal law involving crimes of violence; sexual assault, molestation, exploitation, contact, or prostitution; crimes against persons; or offenses committed against children."
That's a requirement/legal note. Could go under About the role or Requirements. Probably under Requirements (legal). We'll include as a
maybe.
Then "General Summary Working with a motivated Business Office Staff focused on providing access and support of specialty referred care from a Health and Wellness Center environment, by way of coordination of care, management of benefits, approvals of services based on IHS eligibility guidelines, to provide the best customer service and assistance to the population that we serve. Our responsibility is to assure prompt, accurate financial processing, and reporting for our financial obligations."
That's prose.
Then "Primary Responsibilities Primary responsibilities are the basic job duties that an employee must be able to perform. This list of responsibilities is intended to be representative of the duties performed within this classification. The omission of a function does not preclude management from assigning duties not listed if such duties relate to the position."
That's intro prose before list.
Then list of Job Duties (many sentences). We need to turn each sentence into
- . Let's extract each duty:
- Ensure that all Indian Health Contract Health Service requirements are met for all eligible clients/patients and assists in all necessary daily operations of the CHS program.
- Administer contracted health care to eligible clients/patients according to the IHS federal guidelines, and the programs Policy & procedures, as well as federal rules/regulations based on annual funding.
- Responsible for assuming dual responsibility for processing routine and complex health claims as well as providing customer service to both patients and providers.
- Serve as a resource for clients/community members and other Nisqually Tribal Health & Wellness Center staff.
- Conduct a majority of their workday with face to face and phone contact with PRC/CHS eligible clients issuing authorizations for medical care.
- Assists in assuring patient eligibility meets the IHS/PRC guidelines.
- Verifying all alternative medical insurance resources are utilized prior to providing PRC services.
- Generating Purchase Order numbers (PO) through the current PRC operating system, for patients requesting via telephone or in person.
- Matching Explanation of Benefits (EOB) to existing Purchase Orders (PO)
- Verify and document the status of each individual existing Purchase Orders (PO), for completion of the billing process, and to assure payments are made in a timely manner.
- Work with off-site Specialty Providers inquiring about referrals, and services related to physician visits, laboratories, pharmacies, dental providers, and patients via mail or in person.
- Works daily with invoicing of PRC/CHS claims, and the posting of payments.
- Provide answers to referring physicians, and those responsible for their billing, when inquiring about payment status.
- Open and sort incoming correspondence.
- Participates in seminars and meetings that relate to Purchase Referred Care/Contract Health Services.
- Filing and other common clerical duties.
Then "Safety Adheres to safety policies and procedures within the Nisqually Health & Wellness program.Reports inappropriate incidents by filing incident reports and forwarding the report to their immediate supervisor.Respond to emergencies in a calm and professional manner and report to designated area and or person in case of an emergency."
We can make each sentence as
- under Safety maybe.
Then "Communication Represents the Nisqually Tribal Health & Wellness Center in a positive and professional manner when interacting with patients and the community.Demonstrate positive interpersonal relations skills in dealing with staff, providers, and management.Consistently maintains confidentiality and follows HIPAA guidelines, on behalf of the patient and the organization.Participates in staff meetings."
Again each sentence as
- .
Then "Minimun Qualifications Education and Experience Graduation from high school or equivalent.Three years' experience in a Purchased Referred Care or Contract Health Service program or IHS program specific to Tribal health services.Three years' experience processing all types of health/dental claims.Two years in depth knowledge of all aspects of benefits & claims processing.Two years successful customer service background."
We need to split into list items.
- Graduation from high school or equivalent.
- Three years' experience in a Purchased Referred Care or Contract Health Service program or IHS program specific to Tribal health services.
- Three years' experience processing all types of health/dental claims.
- Two years in depth knowledge of all aspects of benefits & claims processing.
- Two years successful customer service background.
Then "Preferred Qualifications Experience in a Tribal PRC/CHS ProgramExperience in medical billing in both ambulatory and hospital settings.Experience and knowledge of state, federal and private insurances.A strong understanding and knowledge of private, state, and federal health insurance practices as it pertains to processing patient in-coming claims.Flexible, self-motivated, independent, detailed oriented and reliable.Experience in customer service.Knowledgeable in CPT and ICD-10 billing codes.Knowledge of medical terminology.Ability to communicate effectively both oral and written.Dependable and prompt."
Split:
- Experience in a Tribal PRC/CHS Program
- Experience in medical billing in both ambulatory and hospital settings.
- Experience and knowledge of state, federal and private insurances.
- A strong understanding and knowledge of private, state, and federal health insurance practices as it pertains to processing patient in-coming claims.
- Flexible, self-motivated, independent, detailed oriented and reliable.
- Experience in customer service.
- Knowledgeable in CPT and ICD-10 billing codes.
- Knowledge of medical terminology.
- Ability to communicate effectively both oral and written.
- Dependable and prompt.
Now we need to decide sections.
We could have:
About the role
General Summary ...
Responsibilities
- ... duties ...
... plus Safety and Communication items maybe also under Responsibilities? Could separate Safety and Communication as own sections but they are not typical headings list; but we could include them as sub-sections under Responsibilities? The instruction says use headings for sections like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. It doesn't forbid other headings, but we should prefer those. Safety and Communication could be considered part of Responsibilities or Skills. I'd include them under Responsibilities as additional items.
Thus Responsibilities section will contain all duties, safety, communication items.
Then Requirements section: include the legal note (NSORNA etc) plus Minimum Qualifications.
Then Qualifications section: Preferred Qualifications.
We should not create Skills section unless there is specific skills content; we have some skills in Preferred Qualifications but we can keep them there.
Now we need to ensure we don't repeat job title. No Job ID.
We need to output only HTML fragment.
Let's craft.
Start with About the role
Working with a motivated Business Office Staff focused on providing access and support of specialty referred care from a Health and Wellness Center environment, by way of coordination of care, management of benefits, approvals of services based on IHS eligibility guidelines, to provide the best customer service and assistance to the population that we serve. Our responsibility is to assure prompt, accurate financial processing, and reporting for our financial obligations.
Then maybe include the legal note as part of Requirements? Actually legal note is about eligibility; could be under Requirements. We'll put it there.
Now Responsibilities: Responsibilities
with each duty.
We need to include the intro sentence about Primary responsibilities? Could be a before list. But instruction: use
for prose. So we can have a
before the list: "Primary responsibilities are the basic job duties that an employee must be able to perform. This list of responsibilities is intended to be representative of the duties performed within this classification. The omission of a function does not preclude management from assigning duties not listed if such duties relate to the position."
Then
- ... each duty.
Then after duties we could add Safety and Communication items as
- as well, but maybe better to keep them under same list? Could add a
before safety: "Safety" then list. But we need headings for sections only if we have specific content. We could add
Safety
and Communication
but those are not in the example list but allowed? The instruction says use for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It doesn't forbid other headings, but we should prefer those. However we can still include Safety and Communication as sub-sections under Responsibilities using
headings? Might be okay to just include them as list items without separate heading.
I'll include them as list items under Responsibilities.
Now Requirements:
Requirements
Please note: NSORNA Nisqually's Sex Offender Registration and Notification Act requires all individuals who have ever been convicted of a sex offense to register with our Public Safety Department. This is true whether or not you have to register with another jurisdiction. This position has regular contact with or control over Indian Children and Vulnerable Adults. In compliance with Federal Law, this position will not be filled by an applicant with any fel
maybe. Then "General Summary Working with a motivated Business Office Staff focused on providing access and support of specialty referred care from a Health and Wellness Center environment, by way of coordination of care, management of benefits, approvals of services based on IHS eligibility guidelines, to provide the best customer service and assistance to the population that we serve. Our responsibility is to assure prompt, accurate financial processing, and reporting for our financial obligations." That's prose. Then "Primary Responsibilities Primary responsibilities are the basic job duties that an employee must be able to perform. This list of responsibilities is intended to be representative of the duties performed within this classification. The omission of a function does not preclude management from assigning duties not listed if such duties relate to the position." That's intro prose before list. Then list of Job Duties (many sentences). We need to turn each sentence into
About the role
General Summary ...
Responsibilities
- ... duties ... ... plus Safety and Communication items maybe also under Responsibilities? Could separate Safety and Communication as own sections but they are not typical headings list; but we could include them as sub-sections under Responsibilities? The instruction says use headings for sections like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. It doesn't forbid other headings, but we should prefer those. Safety and Communication could be considered part of Responsibilities or Skills. I'd include them under Responsibilities as additional items. Thus Responsibilities section will contain all duties, safety, communication items. Then Requirements section: include the legal note (NSORNA etc) plus Minimum Qualifications. Then Qualifications section: Preferred Qualifications. We should not create Skills section unless there is specific skills content; we have some skills in Preferred Qualifications but we can keep them there. Now we need to ensure we don't repeat job title. No Job ID. We need to output only HTML fragment. Let's craft. Start with
- ... each duty. Then after duties we could add Safety and Communication items as
- as well, but maybe better to keep them under same list? Could add a
before safety: "Safety" then list. But we need headings for sections only if we have specific content. We could add
Safety
andCommunication
but those are not in the example list but allowed? The instruction says usefor section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It doesn't forbid other headings, but we should prefer those. However we can still include Safety and Communication as sub-sections under Responsibilities using
headings? Might be okay to just include them as list items without separate heading. I'll include them as list items under Responsibilities. Now Requirements:
Requirements
Please note: NSORNA Nisqually's Sex Offender Registration and Notification Act requires all individuals who have ever been convicted of a sex offense to register with our Public Safety Department. This is true whether or not you have to register with another jurisdiction. This position has regular contact with or control over Indian Children and Vulnerable Adults. In compliance with Federal Law, this position will not be filled by an applicant with any fel
About the role
Working with a motivated Business Office Staff focused on providing access and support of specialty referred care from a Health and Wellness Center environment, by way of coordination of care, management of benefits, approvals of services based on IHS eligibility guidelines, to provide the best customer service and assistance to the population that we serve. Our responsibility is to assure prompt, accurate financial processing, and reporting for our financial obligations.
Then maybe include the legal note as part of Requirements? Actually legal note is about eligibility; could be under Requirements. We'll put it there. Now Responsibilities:Responsibilities
- with each duty.
We need to include the intro sentence about Primary responsibilities? Could be a
before list. But instruction: use
for prose. So we can have a
before the list: "Primary responsibilities are the basic job duties that an employee must be able to perform. This list of responsibilities is intended to be representative of the duties performed within this classification. The omission of a function does not preclude management from assigning duties not listed if such duties relate to the position." Then