Purchased Referred Care Specialist

In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Preference in hiring and employment is given to applicants who meet the necessary qualifications and are (1) enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe, (2) legally married to enrolled members of these tribes and meet residency requirements, or (3) enrolled members of other federally-recognized American Indian Tribes.

About the role

This position initiates the Purchased Referred Care (PRC) application intake process by obtaining information from patients, family members, provider staff within the TCRHCC service area, and professional/non-professional staff from outside private providers. The Specialist updates and maintains the patient registration database, including income information, third-party payer details, and other data required to meet the five eligibility factors of the PRC program.

Responsibilities

• Welcomes and greets patients/visitors in person and/or by telephone; answers or refers inquiries; directs patients/visitors; documents calls and visits; records and delivers messages to appropriate personnel.
• Politely communicates with patients and families during times of emotional, mental, and physical stress.
• Receives and date-stamps daily patient referrals/notifications from patients, TCRHCC providers, and/or other facilities.
• Reviews referrals against TCRHCC electronic medical records to determine if patients meet PRC eligibility criteria, making independent decisions confidently and supporting those decisions.
• Distributes referrals to appropriate outside providers for scheduling appointments, then follows up to obtain appointment dates and times.
• Mails referral and PRC letters to patients with their appointment details.
• Forwards referrals for non-TCRHCC patients to the appropriate service unit within 72 hours of receipt.
• Identifies notifications and attaches appropriate cover sheets, including supporting documentation such as TCRHCC patient face sheets, AHCCCS verification forms, and other alternate resources or claims.
• Compiles corresponding documents and inputs pertinent data into the system to establish records and obtain referrals.
• Researches the electronic health record (EHR) to identify existing medical records for patients and dates of service to prevent duplication.
• Notes case numbers on notifications and other documents for quick referencing and forwards them to Caseworkers for processing.
• Performs daily data entry of referrals/notifications into the PRC management software, establishing patient records and processing claims.
• Educates patients/clients about the PRC scheduling process and obtains necessary documents such as PCC visit notes, lab reports, and radiology reports.
• Explains PRC rules, regulations, eligibility, and policies/procedures.
• Conducts periodic reviews to ensure proper and timely follow-up.
• Interviews patients and/or family members to determine potential eligibility for alternate resources and makes necessary contacts with identified resources.
• Enters notes and actions taken for each record, such as phone calls and purposes.
• Administers day-to-day activities required for the PRC program by initiating PRC medical purchase orders and ensuring issuance within specified time limits.
• Maintains files of all correspondence for future confirmation or referencing.
• Provides information to Health Information Management (HIM) regarding patient names and receiving facilities for accidental injuries and Tort Claims.
• Maintains professional skills by attending in-services, workshops, and participating in continuing education.
• Ensures proper PPE is always worn while on duty, including face masks, gloves, gowns, N95 respirators, and eye/face shields as required.
• Completes routine cleaning and decontamination processes for surfaces contaminated by communicable diseases.
• Performs other duties as assigned.

Requirements

• High School Diploma or GED.
• One year of general clerical experience, including data entry and customer service.
• Record of satisfactory performance in all prior and current employment, as evidenced by positive employment references addressing:
  • Positive working relationships with others and fostering teamwork.
  • High ethical standards with no history of complaints.
  • Reliability and dependability, including reporting to work as scheduled without excessive absences.
  • Effective communication skills to deal with all levels of co-workers.
  • Ability to multi-task, prioritize, and manage time to meet strict deadlines.
• Proficiency with typing and accurate spelling/grammar.
• Completion of Patient Sitter Competency Training (upon hire).
• Above-satisfactory scores on all job interviews, demonstrating the ability to perform essential job functions.
• Successful completion of background and reference checks, including positive employment references from past and current employers.
• Successful completion of fingerprint clearance, physical examinations, and other screenings.
• Submission of all required employment-related documents free of false, misleading, or incomplete information.

Mental and Physical Effort

Physical: Work is mostly sedentary with prolonged sitting, frequent reaching, and occasional standing, walking, driving, bending, climbing, kneeling, crouching, and twisting. Incumbent must occasionally lift and pull over 100 lbs. Sensory requirements include prolonged near vision, color vision, depth perception, and hearing normal speech, as well as occasional far vision and hearing overhead pages.

Mental: Handles problems and deviations in accordance with established instructions, priorities, policies, and program goals. Must cope with high levels of stress, make decisions under pressure, handle anger or hostility calmly, concentrate amid distractions, demonstrate flexibility, and manage multiple priorities in stressful situations. Frequently works alone and occasionally manages altercations. Must adapt to shift work and work in close, crowded areas.

Environmental Conditions

May have occasional exposure to infectious diseases, chemical agents, dust, fumes, gases, extremes in temperature or humidity, hazardous or moving equipment, unprotected heights, and loud noises.