Contact Representative (PRC)

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.