The Confederated Tribes of Grand Ronde · 23 hours ago
Certified Applications Assistor-PRC Assistant
Grand Ronde, OR 97347, USA
Full-time
Onsite
Entry Level
$24.60/hr - $31.84/hr
2+ years expThe Confederated Tribes of Grand Ronde is seeking a Certified Applications Assistor-PRC Assistant to coordinate patient benefits and assist Tribal Members with health coverage. The role involves administrative duties related to PRC functions, patient advocacy, and ensuring compliance with health program guidelines.
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Responsibilities
Coordinates benefits with provider through means of patient referrals, discussing individual cases to ensure continuity of care and follow up of care
Ensure the integrity of data entered for PRC check processing; assists with claims processing, pre-report, document control register, vendor payment, vendor claim report, object class code report, and checks printed report
Performs administrative duties assigned to the PRC function such as: PRC deferred services reports, assists with processing catastrophic caseload, maintains records, files as required and assists with mailing checks and scanning PRC information into designated system
Coordinates benefits and assists Tribal Members/PRC with plan changes to ensure proper use of all network discounts and alternate resources available
Works closely, communicating and coordinating information with PRC staff
Maintains TTF deferred services log
Administers Tribal Trust Fund money for deferred services and direct care patients as directed
Tracks and generates patient warning letters for patients not in compliance with PRC and tribal member health program guidelines
Documents PRC refunds in a timely manner
Mails Vendor Payment document and Vendor Denial Correspondence
Issues payment denials for PRC and tribal member health program
Exports TPA PRC check file via RPMS to FileZilla
Ensures proper internal control and security of PRC and Tribal Trust Fund checks
Loads, verifies accuracy and processes claims for Tribal member health program, manually and via an imported file from the TPA
Provide outreach and enrollment assistance to those eligible to access health coverage through Cover Oregon
Act as an advocate for patients seeking health care by explaining, teaching and enrolling patients in an alternative resource program
Implement a screening, interview process and policies for maximum identification of possible applicants
Assist the applicant with any questions regarding health insurance, healthcare access and other resources
Disseminate information about low and no-cost health insurance to families
Receive referrals from collaborating and partner agencies
Acquire any information concerning alternate resources
Advocate effectively for needs of families
Present health concepts to individuals and small groups
Attend meetings and trainings including; but not limited to, Tribal general council meetings and organization meetings
Prepare monthly quantitative and qualitative report on application assistance activities
Assist with retention activities by making retention follow up phone calls, conducting surveys
Coordinates planning for all on-site and off-site meetings and events
Bring feedback from patient experience to improve access to health care
Maintains patient/client correspondence and follow-up files
Refer patients/clients to other available alternate resources when needed
Attends community events to promote, educate and enroll families into various health insurance programs
Participates in discussion about confidential/sensitive matters, maintains confidentiality of patients at all times
Performs a variety of other duties as assigned by supervisor
Qualification
Required
Requires a high school diploma or GED required
Requires two (2) years of office and clerical experience
Must maintain a valid Oregon driver's license or obtain one upon hire, qualify for the Tribe's vehicle insurance, and provide proof of personal vehicle insurance
Requires knowledge of Medicaid, Medicare and other insurance guidelines and regulations
Must have excellent communication, influencing and presentation skills
Must become a Certified Application Assister through Oregon Health Authority and certified through the Federally Facilitated Marketplace within 6 months of hire
Must be able to read and understand technical documents
Must be a self-starter, strong leader, conceptual thinker with ability to advise and challenge
Excellent analytical and decision making skills required
Knowledge of ethical and legal requirements and restrictions pertaining to the maintenance of client records, as well as facility policies, HIPAA and other federal regulations
Requires considerable tact with daily patient contact; approving or denying authorization of payment for PRC services, encouraging patients to apply for alternate resources, gathering information regarding patient insurance, providing information regarding PRC system, eligibility and process
Requires working knowledge and proficiency in use of office equipment and computer software such as Microsoft Word, Excel, Power point, and Outlook
Requires excellent verbal and written communication skills, business and telephone etiquette
Must have excellent organizational skills, attention to detail and record keeping skills
Must have ability to respond courteously and tactfully to complaints and client requests, and to maintain confidentiality
Preferred
Associate's degree preferred
Knowledge of health care and social service resources preferred
Company
The Confederated Tribes of Grand Ronde
Tribal Government
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase