Contact Representative (PRC)
Department of Health and Human Services
Job Title
Help
Duties
Apply and interpret federal, state, Tribal, and private-sector regulations to determine patient eligibility and funding for healthcare programs.
Analyze medical, financial, and eligibility documentation to resolve complex benefit, authorization, and coverage issues.
Issue medical authorizations or denial determinations and coordinate with patients, providers, and agencies to support continuity of care.
Maintain fund control records, monitor expenditures, apply accounting codes, and resolve program or funding discrepancies.
Compile and analyze reports related to program operations, funding, and utilization.
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