Easter Seals Jobs

This job was posted by https://joblink.maine.gov : For more information, please see: https://joblink.maine.gov/jobs/1169095

SUMMARY OF POSITION: The Purchased Referred Care (PRC) Technician (hereinafter, the PRC Tech) is responsible for the provision of payment for referred (offsite, contracted) healthcare services rendered to eligible tribal-member enrollees of the Micmac Family Clinic. The PRC Tech works cooperatively with off-site health care providers, to deliver seamless, comprehensive healthcare services for the members of the ABM community. The PRC tech will research claims and enter purchase orders, reprice claims using Encoder pro, authorize payment for pharmacy services, perform record retrieval and scanning PRC documents, mailing checks and completing payment in RPMS, research aged purchase orders and initiate follow up for documentation needed to finalize payment.

EDUCATION (AND PERTINENT EXPERIENCE): High School Diploma or GED with preference for an Associate\'s Degree in a related field (ex. Medical Office Assistant) and/or at least two (2) years\' experience working in office administration.

LICENSES OR CERTIFICATION: Possess a valid driver\'s license.

SKILLS/KNOWLEDGE/ABILITIES REQUIRED: Basic computer skills. Accounting and bookkeeping experience. Understanding of basic medical terminology and procedures. Excellent communication (both written and oral), and organizational skills. Ability to deal effectively with people, and be sensitive to the needs of the people.

WORKING ENVIRONMMENT: Regular office environment, primarily on-site. Must be willing to travel throughout Aroostook County utilizing any agency vehicles available, or personal vehicle. Will also travel throughout the State of Maine and out-of-state.

Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions.

FUNCTIONS/TASKS:

1. Ensures proper adherence to regulations and policies that apply to the PRC program, including its Purchase Order (PO) system of payment for off-site referred health care services. Ensures that all obligations made, by both the PRC program, and the affected healthcare provider, are in accordance with these regulations and policies.

{=html} <!-- --> 1. Authorizes payment for off-site heath provider services, only after receipt, and thorough examination of, required medical documentation furnished by off-site providers, post visits. Ensures that payment is made to medical providers within thirty (30) days. Maintains a record of these payments. 2. Determine patient eligibility for Purchase Referred Care. 3. Determine alternate health care resources to provide services to patients. 4. Copying and mailing provider/vendor checks weekly, to include paying the claim in our RPMS system.

{=html} <!-- --> 6. Authorizing payment for pharmacy charges for eligible patients as needed.

{=html} <!-- --> 1. Researching incoming claims for completeness of ICD-IO/CPT/ADA codes with accompanying explanation of benefits (EOB). 2. Reprice claims using Encoder pro system.

{=html} <!-- --> 9. Retrieves and compiles medical records data as they pertain to PRC. 10. Scanning of PRC records into patient charts. 11. Filing paid PRC POs/claims in chronological order. 12. Follows-up on all Purchase Orders sent to medical providers that are not returned within two (2) months to include claims missing codes or EOBs. 13. Ensures that all ABM and IHS reporting requirements, relative to assigned duties, occur on a timely basis.

{=html} <!-- --> 1. Maintains strict adherence to all ABM Personnel Policies. 2. Reviews and adheres to the Privacy Act and HIPPA rules and regulations. Monitors and enforces compliance of staff with All applicable rules and regulations governin the privacy and confidentiality of patients, Health Department and IHS data and information. 3. Attends all required trainings and assigned meetings. 4. Reports to work, meetings, trainings, and scheduled appointments on time. 5. Consents to a State of Maine Criminal Background and DHHS checks and have no significant findings.

{=html} <!-- --> 19. Reviews, signs, and adheres to the Privacy Act of 1974, and Confidentiality Statement. 20. Reports to the Business Office Manager, of significant findings in relation to health matters that come to his/her attention during the performance of official duties. 21. Caries out additional duties as assigned by the Business Office Manager.

NOTICE: This Position Description in no way implies that the responsibilities and tasks are the only responsibilities and tasks performed by the Purchased Referred Care Technician occupying this position. S/he will be required to follow any other instructions necessary to perform any job-related duties as required by his/her immediate supervisor.

Requirements stated herein are minimum levels of knowledge, skills, and/or abilities, to qualify for this position. To perform the scope of work, duties, and responsibilities of this position successfully