Contact Representative (PRC)
1 week ago
Receives notification and referrals for non-IHS and IHS referred care.....
- Receives notification and referrals for non-IHS and IHS referred care through hard copy or the automated referred care system. Enters or edits all referrals. Ensures accurate data entry in order to retrieve meaningful reports.
- Verifies and determines patient's eligibility for Medicare, Medicaid, Private Insurance, VA or other potential alternate resources as appropriate, which are available and accessible to the individual. Develops and implements procedural guides; compiles and interprets various alternate resource references and guides.
- Ensures that PRC funds are available prior to issuance of obligating documents on behalf of the government. Provides forecasting of weekly document control register balances after each week's obligations have been completed to ensure funds are expended in accordance within spending plans.
- Maintains complete fund control records for health services funds allotted. Ensures the presence of accurate information, monitors activities and records pertaining to the fiscal management of funds. Identifies problem areas and recommends corrective action. Reconciles the commitment register to the automated financial system.
- Issues correspondence to patients, health care providers and other agencies regarding eligibility, IHS policy and regulations, including letters of denial of payment where the requirements of the IHS Program are not met. Maintains program files including letters of denials with all backup material for reason for denial, elective procedures, etc. Completes timely response to Service Unit Appeals through review of case files and all supporting information. Maintains appeal record files in keeping with the appeal process contained in federal regulations or policies.
- Tracks all referrals to non-IHS facilities to include those referrals to other IHS facilities to support the Case Management activities and continuity of care efforts. Participates in the weekly Case Management meetings, takes minutes and prepares the minutes for record and reporting purpose. Researches and follow up with non-IHS facilities on weekly basis for current medical status and costs to determine whether the case will be a Catastrophic Health Emergency Fund (CHEF) case.
Starting at $44,808 Per Year (GS 6-8)
Official account of Jobstore.