Purchased Referred Care Supervisor

Definition

Under general administrative program supervision of the Purchased Referred Care Manager. This position oversees the daily operations and supervises the Referral Coordinators of the Salt River Purchased Referred Care Department including coordination and monitoring all PRC referrals serves as an advisor on the PRC program on policy implementation andinterpretation program planning program development administration management operation and evaluation of a comprehensive PRC program. This job class is treated as FLSA-Exempt.

Essential Functions: Essential functions may vary among positions and may include the following tasks and other characteristics. This list of tasks is ILLUSTRATIVE ONLY and is not intended to be comprehensive listing of tasks performed by all positions in this classification.

Examples of Tasks

• Workflow Direction and Supervision: Direct supervision of PRC Referral Coordinators training and guidance in the maintenance/safekeeping of patient medical referrals while maintaining security confidentiality accuracy completeness and accessibility of health information.
  • Schedules and supervises the work of assigned staff to achieve the defined business goals and to ensure smooth workflow in the department.
  • Coordinates team activities and the staff to workload ratios to accomplish the most effective use of resources.
  • Sets work goals for team members and monitors measurable outcomes in accuracy timeliness productivity and service quality.
  • Provides leadership work goals and coaching for staff. Participates in selecting hires and trains staff for assigned duties
  • Develops and promotes strong inter-departmental teamwork to meet the needs of the patients and providers and drives decision-making and other actions. Provides training and guidance to new PRC staff members with the PRC workflow
  • Conducts performance reviews coaching/disciplinary action and termination of assigned staff following the Communitys personnel policies .
  • Uses advanced business and software skills for creating documents letters spreadsheets reports and presentations. Identifies training needs and provides and/or arranges for needed training.
  • Approves leave requests provides advice counsel or instructions to employees on both work and administrative matters.
  • Identifies and implements changes regarding policy productivity and quality measures and assures that staff performance improvements related to work-flow efficiencies and operations.
  • Provide support and technical assistance to the PRC Referral Coordinators on matters involving referrals for medical surgical dental hospital and clinical services to all eligible beneficiaries.
  • Performs liaison functions with contract health providers state and local agencies; and monitors/reports status of PRC activities and funds.
  • Establish community and payor relationships while maintaining compliance with payment and financial analysis to ensure effective department functions.
  • Prepares analytical data staff reports and memoranda which reflect utilization of PRC funding resources.
  • Maintain up-to-date knowledge on regulatory changes for effective management of the health record system and PRC program and guidelines
  • Develops recommends and implements changes to the PRC policies procedures and Standard Operating Procedure (SOP)
  • Ability to demonstrate Customer Service/Conflict Resolution Experience.
  • Performs other duties as assigned.
• Measurement and Evaluation of Performance:
  • Prepares monthly statistical reports on data quality individual PRC Referral Coordinator assigned patient referrals and assures the issuance of Purchase Orders/claim payments to providers are within specified time limits.
• Patient Eligibility/Interaction: Ensures the PRC Referral Coordinators are adhering to the following;
  • Knowledge of alternate resources: state Medicaid Medicare Medicare Advantage Plans Private Insurances Tribal Health Insurance
  • Screens all cases for PRC eligibility
  • Ensures all eligibility factors are met prior to obligating PRC funds
  • Refers patients to the Benefit Coordinators to apply for alternate resources when they are potentially eligible and documents efforts.
• Performs other related duties as assigned.

Knowledge Skills Abilities and Other Characteristics:

• Knowledge of the culture customs traditions history and government of the Salt River Pima- Maricopa Indian Community.
• Knowledge of the federal Freedom of Information Act Privacy Act and HIPAA laws as they pertain to the SRPMIC work environment.
• Knowledge of PRC programs and regulations
• Knowledge of RPMS packages: RCIS CHSMIS EHR Patient Registration and BCBS Fiscal Intermediary (FI)
• Knowledge of AHCCS online Novitas online and other insurance eligibility online eligibility systems.
• Knowledge of various clinical systems walk-ins and appointments to avoid unnecessary delay and/or confusion on the part of patient.
• Knowledge of various medical services offered by the clinic.
• Knowledge of patient business functions and processes to augment Third Party Billing activities and routines.
• Knowledge of CPT ICD-10 HCPCS and dental coding and billing activities. Ability to understand and comply with the requirements of the Privacy Act HIPAA and maintaining confidentiality of patient information
• Knowledge of alternate resources: State Medicaid (AHCCCS) Medicare Medicare Advantage Plans Private insurance Tribal Self-Insured insurance plans and other related programs.
• Knowledge of administrative/clerical procedures and systems (e.g. equipment file management software programs etc.)
• Ability to manage employees in a high-stress environment.
• Fosters teamwork and a positive working relationship with others
• Ability to use excellent communication skills both verbally and in writing to deal effectively with all levels of co-workers
• Possession of high ethical standards. Ability to work independently multi-task prioritize and manage time to strict deadlines
• Reliable and dependable; adheres to work schedule and SRPMIC attendance policies.
• Knowledge of medical terminology and medical care practices and procedures
• Knowledge of CPT ICD-10 and HCPCS coding

Minimum Qualifications

Education: High school diploma or GED required; 4-year college degree preferred.

Experience: Minimum of 3 years full-time work experience managing and leading staff.

• Experience working with health record patient referrals and scheduling preferred
• 2 years experience (minimum) with employee performance management (e.g. evaluations technical assistance corrective action etc.)
• 2 years experience in medical administrative support medical billing and/or Purchase Referred care role

Equivalency: Any equivalent combination of education and/or experience that would allow the candidate to satisfactorily perform the duties of this position will be considered.

Underfill Eligibility: An enrolled Community Member whom closely qualifies for the minimum qualifications for a position may be considered for employment under SRPMIC Policy 2-19 Underfill.

Special Requirements

Special Requirements May be required to work beyond normal work hours including nights weekends and holidays.

• Employees in and applicants applying for jobs providing direct services to children are subject to the Community Code of Ordinances Chapter 11 Minors Article X. Investigation of Persons Working With Children.
• Ensures all patient information is kept confidential and complies with Health Insurance Portability and Accountability Act (HIPAA) regulations and SRPMIC HHS policies and procedures.

Prior to hire as an employee applicants will be subject to drug and alcohol testing. Will be required to pass a pre-employment background/fingerprint check.

SRPMIC is an Equal Opportunity/Affirmative Action Employer Preference will be given to a qualified : Community Member Veteran Community Member Spouse of Community Member qualified Native American and then other qualified candidate.

In order to obtain preference the following is required: 1) Qualified Community Member Veteran (DD-214) will be required at the time of application submission 2) Qualified Community Member (must provide Tribal I.D at time of application submission)3) Spouse of a Community Member (Marriage License/certificate and spouse Tribal ID or CIB is required at time of application submission) and 4) Native American (Tribal ID or CIB required at time of application submission).

Documents may be submitted by one of the following methods:

1) attach to application

2) fax

3) mail or hand deliver to Human Resources.

4.) email to

Documentation must be received by position closing date.

Required Experience:

Manager