This position is located in the Purchased Referred Care (PRC) Office at the Uintah & Ouray Service Unit in Ft. Duchesne UT. Provides services to eligible beneficiaries located in the Purchase Referred Care delivery area.

Duties

Determines patient eligibility for care under the PRC Program. Requires the application of PRC rules and regulations, facility proximity, tribal membership, residence, close social and economic ties, and students and transient's status. Determines the priority for services provided under the PRC program based upon priorities established for relative medical needs. Defines Direct Care as it relates to the Purchase Referred Care regulations. Approves, denies or pends direct care referrals based on the eligibility criteria, priority of care and direct care in accordance with the PRC regulations. Prepares the referral activities report, emergency room notifications and consultations for the PRC committee meetings twice weekly. Determines alternate resources available to patients under the PRC program and independently determines patient eligibility for Medicare, Medicaid, Medical, Vocational Rehabilitation, Veterans Administration, Crippled Children's, private insurance, state programs, and other applicable resources. Coordinates and obtains prior authorizations from Primary Payers, Insurances, Medicaid and Medicare for PRC eligible patients with approved PRC referrals. Counsels and advises patients of their PRC eligibility status, available alternate resources, available patient benefits coordination, scheduled referral appointments, dates, times, locations and contacts the contracted provider for pre-diagnostic or procedural orders. Prepares responses to routine correspondence, compiles information, and prepares periodic and special reports concerning contract services for submission to the Area Office and others.

Requirements

Qualifications

To qualify for this position, your resume must state sufficient experience and/or education, to perform the duties of the specific position for which you are applying. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community; social). You will receive credit for all qualifying experience, including volunteer and part time experience. You must clearly identify the duties and responsibilities in each position held and the total number of hours per week. BASIC REQUIREMENT(S): GS-5: One (1) year of specialized experience equivalent to at least the GS-4 grade level; and/or four (4) years above high school GS-6: One (1) year of specialized experience equivalent to at least the GS-5 grade level .Examples of Specialized Experience: For GS-5 level, you must have one year of experience (equivalent to the GS-4) that included duties such: Obligate funds in automated data system. Respond to inquiries and requests through telephone, correspondence and personal visits. Identify errors in data and take corrective action. Communicate with vendors, contractors and third parties. Maintain files. Providing administrative support. For GS-6 level, you must have one year of experience (equivalent to the GS-5) that included duties such as: Assure funds have been obligated within deadlines and unused obligations are canceled. Being responsible for making sure transactions affecting funds are promptly processed. Effectively communicate with fiscal intermediaries, vendors and contractors. Review invoices to determine if authorizations have been issued. Research and take appropriate action on authorization errors/issues. Assist in determining patient eligibility. Respond to Purchased/Referred Care (PRC) inquiries through telephone, correspondence and personal visits. Identifies error messages in Resource Patient Management System and take corrective action. You must meet all qualification requirements the closing date of the announcement.

Education

There are no education requirements.

Contacts

• Address Uintah Ouray Service Unit PO Box 160 Fort Duchesne, UT 84026 US
• Name: Renee Cunliffe
• Phone: 928-498-7075
• Email: [email protected]