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10 days old

Purchased Referred Care (PRC)

Kelly Services
Anchorage, AK 99503
**Job Description**


Job Description

JOB SUMMARY: Under general supervision, perform tasks on behalf of Alaska Native Tribal Health Consortium Specialty Clinic Departments and ANMC Purchased Referred Care (PRC) for the purposes of efficiently and accurately assisting in executing all aspects of the external referral and emergent authorization process. Promote the quality and cost effectiveness of referred medical care by processing pre-authorizations in collaboration with medical providers, nursing staff, and other patient care support staff.

The following duties are intended to provide a representative summary of the major duties and responsibilities and ARE NOT intended to serve as a comprehensive list of all duties performed by all employees in this classification. Incumbent(s) may not be required to perform all duties listed and may be required to perform additional, position-specific duties.

REPRESENTATIVE DUTIES

PRC Referral Coordinator I-II:

Monitor the Electronic Health Record (EHR) notifications and established referral systems throughout the day to capture, process, and document external medical referral requests according to standard operational procedures.

Preform daily and/or period review of pending external medical referrals to identify health services that will require pre-authorization. Work closely with the specialty clinic and PRC nurse case managers to provide authorization(s) according to approved policies and procedures of the ANMC PRC program.

Gather pertinent information, including patient demographic and clinical information such as eligibility, health screening, insurance status, medical priority, referring service and provider(s), and purpose of referral.

Accurately complete referrals for PRC authorization within established timeframes and provides status of the request to the referring service. Communicate with referring service, case manager, health benefits team, or central registration team for any identified issues and/or requirements.

Assists referring specialty clinics in providing an eligibility/referral card to patients referred out of ANMC for scheduled care. Sends Provider Notification Letters (PNL) to external provider and/or facility to communicate the pre-authorization of services and coordination of benefits for the primary referral.

Enrolls new students into ANMC PRC Student Program according to established policies and procedures. Assists with submitting patient registration worksheets to Central Registration if needed. Requests and verifies supporting documents for enrollment including proof of full-time admission, eligibility, etc.

Performs other duties as assigned, related to ANTHC PRC program and initiatives.

PRC Referral Coordinator III:

In addition to the duties for level I-II. PRC REFERRAL COORDINATOR (JOB FAMILY) Page 2 of 3

Works closely with other clinical and administrative staff to ensure appropriate analysis, prioritization, and coordinated response to pre-authorization requests for secondary referrals.

Communicates back to the referring service and PRC case manager for additional authorization(s) and/or transition of care to ANMC.

Assists in the documentation of emergent authorizations as notified by the authorizing provider, Transfer Call Center staff, and/or PRC case manager. Enters PRC authorization in the electronic health record and established referral system according to standard operational procedures. Provides PNL to external provider and/or facility to communicate the authorization of emergent services and coordination of benefits.

Provides internal and external training on PRC referral process and Student Program requirements. Recommends and reviews changes in adult learning strategies and training methods. Research, analyze, and evaluate new training materials. Assist in design of training manuals and related materials to support a fully integrated learning management system.

Maintain ongoing tracking and reporting of the number of pre-authorizations that were referred back to ANMC for ancillary services.

As the lead referral coordinator assists with the management of assigned staff; assigns tasks and priorities; recommends corrective action and performance evaluations; maintains timekeeping for assigned staff.

Required Skills


KNOWLEDGE and SKILLS


All

- Knowledge of applicable federal, state, and tribal healthcare programs.

- Knowledge of state, federal, and public/private insurance carrier regulations including Centers for Medicare and Medicaid.

- Knowledge of general medical terminology, anatomy, physiology and concepts of diseases.

- Knowledge of ICD-10 and CPT coding.

- Knowledge of the Privacy Act of 1974 and HIPAA Privacy Rule Act of 1966.

- Skill in customer service with strong communication skills using the telephone and electronic media

- Skill in operation of a personal computer utilizing various software including electronic health records and on-line application processes

- Skill in assessing and prioritizing multiple tasks, projects, and demands.

- Skill in written and oral communication.


Required Experience

MINIMUM EDUCATION QUALIFICATION


PRC Referral Coordinator I:

High school diploma or GED Equivalent

PRC Referral Coordinator II-III:

Associate-level college degree and/or certification in medical coding, accounting, or management required. Progressively responsible professional work experience may be substituted on a year-for-year basis for college education.

MINIMUM EXPERIENCE QUALIFICATION

PRC Referral Coordinator I:

Non-Supervisory - One (1) year professional work experience in a clinical setting preferred; AND two (1) years- experience in medical referrals, or other related medical patient support function in a clinical setting.

PRC Referral Coordinator II:

Non-supervisory - Two (2) years professional work experience in a clinical setting preferred; AND two (2) years- experience in medical referrals, or other related medical patient support functions in a clinical setting.


PRC Referral Coordinator III:


Non-supervisory - Three (3) years professional work experience in a clinical setting preferred; AND three (3) years- experience in medical referrals, or other related medical patient support functions in a clinical setting.


Supervisory - One (1) year involving employee supervision.


**Why Kelly** **** **?**



As a worker today, its up to you to take charge of your career and look for opportunities to learn, grow, and achieve your potential. Helping
you find whats next is what were all about. We know whats going on in the evolving world of workjust ask the nearly 500,000 people we employ
each year. Connecting with us means getting the support, guidance, and opportunities needed to take your career where you may have never imagined.




**About Kelly** ****



At Kelly, were always thinking about whats next and advising job seekers on new ways of working to reach their full potential. In fact, were a
leading advocate for temporary/nontraditional workstyles, because we believe they allow flexibility and tremendous growth opportunities that enable
a better way to work and live. Connecting great people with great companies is what we do best, and our employment opportunities span a wide variety
of workstyles, skill levels, and industries around the world.


Kelly is an equal opportunity employer committed to employing a diverse workforce, including, but not limited to, minorities, females,
individuals with disabilities, protected veterans, sexual orientation, gender identity. Equal Employment Opportunity is The Law.
Posted: 2019-11-01 Expires: 2019-12-02

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Purchased Referred Care (PRC)

Kelly Services
Anchorage, AK 99503

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