Contact Representative (PRC)
Department of Health and Human Services
Job Title
The role involves assisting in the application and interpretation of various regulations to determine patient eligibility and funding for healthcare programs.
Key responsibilities include:
- Applying and interpreting federal, state, Tribal, and private-sector regulations to determine patient eligibility and funding for healthcare programs.
- Analyzing medical, financial, and eligibility documentation to resolve complex benefit, authorization, and coverage issues.
- Issuing medical authorizations or denial determinations and coordinating with patients, providers, and agencies to support continuity of care.
- Maintaining fund control records, monitoring expenditures, applying accounting codes, and resolving program or funding discrepancies.
- Compiling and analyzing reports related to program operations, funding, and utilization.
Vacancy posted 4 days ago
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