______POSITION DESCRIPTION______

POSITION:PURCHASED REFERRED CARE ADMINISTRATOR

DEPARTMENT:Ellen Marshall CenterGRADE: DOE

REPORTS TO:Health & Human Services DirectorSTATUS: Non-Exempt

POSITION SUMMARY:

The Purchased Referred Care Administrator will be directly responsible to the Health and Human Services Director.

ESSENTIAL FUNCTIONS:

  1. Perform initial screening of persons to determine eligibility for Purchased Referred Care Services. Update eligibility status every six months.
  2. Authorize medical and dental care for eligible persons in accordance with Purchased Referred Care regulations and health priorities established by the Bay Mills Health Board.
  3. Maintain confidential files containing client information, vouchers, referrals and other related files in accordance payment resources to tribal members.
  4. Compile and provide necessary information to accounting department to ensure timely payment of vouchers.
  5. Responsible for scheduling monthly Health Board Meetings.
  6. Ensure that PRC budgetary limits are not exceeded.
  7. Provide financial reports to the Health Director and the Bay Mills Health Board on a monthly basis or as requested.
  8. Provide copies of all correspondence to Health Director.
  9. Assist tribal members in obtaining payment from private insurance or other resources. Becomes a Certified Assistant Counselor.
  10. Supervises Purchased Referred Care Assistant.
  11. Recorded cause of death on tribal member. Thantological Review.
  12. Assists with the implementation of Medicare Like Rates, determining eligibility of cost/benefit ratio of tribal member insurance eligibility.
  13. Must attend all mandatory or departmental training offered by the Bay Mills Human Resource Department.
  14. Other duties may be assigned within the scope and complexity of this position’s essential functions.

PHYSICAL REQUIREMENTS:

While performing the duties of this job, the employee is regularly required to sit, stand, and walk. The work performed is in an office setting technological support.

POSITION REQUIREMENTS:

  1. High school diploma or G.E.D.
  2. Need to be familiar with DX code.
  3. Must have customer service skillsand be able to deescalate upset customers.
  4. Musthave computer skillswith PRMS, Microsoft and Excel.
  5. Knowledge of Purchased Referred Care preferred.
  6. Experience in health related fields preferred, but not necessary.
  7. Indian Health Services PRC guidelines and regulations must be followed.
  8. General guidelines contained within the Indian Health Service contract must be followed.
  9. Specific tribal guidelines and policies set by the Tribal Health Board must be adhered to.
  10. Must have a valid driver’s license and be able to travel.
  11. Maintains the confidentiality of the health program and its clients and be HIPAA compliant.
  12. Must have an excellent past work history, must be reliable and timely.
  13. Must have excellent communication skills: both written and verbal.
  14. To perform this position successfully, the individual must be able to satisfactorily perform each function listed under the essential functions and physical demands categories of this position description.

ADDITIONAL INFORMATION: This position may be restricted to qualified applicants already working within the Health Department

PREFERENCE:Preference will be given to those of Native American descent.

CLOSING DATE: October 13, 2016 (4:30pm)

APPLY TO:Send Resume and/or Application to:

Heather Lyons; Recruiter

Bay Mills Human Resources Department

12124 W. Lakeshore Drive

Brimley, MI 49715

Subject: Purchased Referred Care Administrator