Employment Opportunities
Contract Health/PRC Specialist
This position has been filled.
Public?:
Internal
Division:
Health
Reports To:
Director (PRC) Department
Type of Position:
Regular Full Time
Location:
Little Axe Health Center / 15951 Little Axe Dr. / Norman, OK 73026
General Description
This position is located at LI-SI-WI-NWI in Norman, Oklahoma within the Contract Health/PRC Department. This position serves as the liaison between the Absentee Shawnee Tribe, the patients and the third party care providers to whom/what the patients have been referred. The incumbent is under direct supervision of the Lead PRC Claims specialist, administrative supervision of the Director (PRC) Department and medical supervision of Case Manager (PRC) Department.
Responsibilites
Communicates and coordinates daily with Lead Claims Specialist and Contract Health/PRC Supervisors, various health program entities, physicians and other health care providers to aid in the processing of claims for Absentee Shawnee tribal members.
Works with CASE MANAGER LPN, in learning, the process and authorization of outsourcing medical visits.
Communicates with the patients attending physicians when necessary.
Processes incoming claims on daily bases for accuracy of items billed by outside providers
Complete and submit CHEF cases.
Daily medical records review when processing all claims for eligibility.
Process Private Insurance claims with explanation of benefits.
IHS Area Office Chef interlink project.
Assist in running weekly reports for Purchase Authorization submitted to Tribal Finance for payment.
Other duties as assigned.
This job description should not be interpreted as all inclusive. It identifies major responsibilities and requirements of this job. The incumbent may be requested to perform other related or non-related tasks at any time.
Education, Qualifications & Requirements
Minimum Qualifications:
Must have completed courses in Medical Terminology /Medical Coding
Electronic Health Records knowledge
Must become familiar with Health Benefits Guidelines per member.
Preferred Qualifications: (or Knowledge, Skills and Abilities)
This position requires a working knowledge and understanding of standards of billing practice, in processing medical claims must be able to understand insurance explanation of benefits.
Computer and typing skills are required. With additional knowledge in all computer software programs.
Supervision Requirements:
Must be able to perform essential duties with minimal direct supervision. Must possess excellent judgment as related to reporting authorization of outside provider visits.
This position is under the supervision of the Contract Health PRC Director and Case Manager and is responsible for directly reporting to each as needed. Also reporting to Lead Claims manager, on duties specific to claims processed.
Required Physical Demands:
Keyboarding/Dexterity, must be able to effectively speak, and able to effectively communicate verbally;
Must not be restricted with vision and hearing to complete assigned duties.
Native American Preference/EEO/Drug Free /Smoke Free Workplace
Posted Date:
1 year 10 months ago