Purchased Referred Care Assistant

TITLE:                       Purchased Referred Care Assistant

POSITON:                 Part-Time

SUPERVISOR:         KNHC Director

Position Description:

This position is organizationally located in the Purchased Referred Care (PRC) Branch,

 Kickapoo Nation Health Center Service Unit, Indian Health Service.  The function of the Purchased Referred Care office is providing medical care for eligible Indian beneficiaries.  The incumbent serves as Service Unit PRC Health System Specialist under the general administrative and professional direction of the Director. Individual is responsible for providing support for the administration of the Service Unit PRC program.  The incumbent is responsible for participating in the administration of Direct Patient Care and use of alternate health care and alternate health care resources in order to provide total comprehensive health service for the Service Unit Indian Population.

Essential Responsibilities:

1. Incumbent is responsible for assisting in determining patient eligibility, scope, and priority for the PRC program. Responds to PRC inquiries and requests for PRC assistance that are          made to the Service Unit Director.  Such responses are through telephone, correspondence,          and personal visits with consumers.  Responds to inquiries and requests with Service Unit            staff, including medical, social service, dental, etc., and private sector health resources.                 Incumbent is responsible for implementation of decisions made for the provision or denial           of services.  Incumbent works as part of the Service Unit PRC team in the planning,                     coordination, and management of the health care delivery system.

Incumbent is responsible for effective and maximum utilization of PRC funds, and for                 maintaining a follow up system.

1. 
   Incumbent maintains the Service Unit Commitment Register for PRC Funds for medical and dental services. Responsible for maintaining a register of all requests for additional funding, such as:  Deferred Services, High Risk OB and Priority I denials (not within medical priority).  Compiles reports of statistical and fiscal data necessary to determine funds required to meet the need of the PRC Program for the Service Unit.  Through current and historic fund expenditure analysis, review of health status indicators, and knowledge of health care needs, monitors PRC funds status for the Service Unit, and                    makes recommendations for reprogramming of funds or requests for additional funding.               Prepares all PRC financial status reports, budget needs, forecasts, and other required PRC            reports for Service Unit and Area Office, responding on a timely basis to meet deadlines.              Responsible for PRC funds control.  Reconciles with Area Financial Management                        Reports, and Fiscal Intermediary, keeping Supervisor, Service Unit staff and tribes                        advised on current fund status. 

1. 
   Assists with the reporting of Catastrophic Health Emergency Fund (CHEF) cases. Works closely with Service Unit PRC staff, Medical Officers, and Area PRC office to report, manage, and monitor the high cost cases funded through the CHEF program as                             established by P.L. 100-713 Section 202.  Ensures timely close out of CHEF cases and                 provide periodic site visit to Service Units to assist the PRC staff.

1. 
   Incumbent is responsible for keeping up-to-date pending and completed PRC patient files, with documented status of all written and verbal transactions. Performs periodic spot reviews and audits of completed authorization forms and other documents to insure consistent correct use of allotment, object, sub-object, and sub-activity coding required by Area Financial Management.  Forms are also audited and reviewed to insure correct diagnosis and diagnosis coding required by Area Health records and Program Planning and Analysis.  These data are reflected in the IHS Data system for use in Budget forecasts, Budget preparations and Budget justifications and Program Planning.

1. 
   Works with Service Unit professional and para-professional staff, local providers, tribal health committee and Area Office staff. Serves as representative of Service Unit Director at tribal meetings, hospitals, physicians, etc., for the purpose of creating and maintaining an understanding of the PRC programs, and to promote consumer and provider satisfaction.

1. 
   Incumbent must have knowledge of computer application relating to the Contract Health Program, including the responsibility for key entering and verifying all PRC authorizations, payments, cancellations, and supplements. Maintains obligation registers and all other Contract Health documents. Responsible for the weekly printing of all documents and the Document Control Register through the use of the menu driven PRC Computer Program.  Must have knowledge to establish proper top of form line, form length and proper forms to be loaded into the printer.  Responsible for printing of address labels, and all PRC Documents and accomplish printing in the absence of the Programmer.  Responsible for adding, deleting, changing, and verifying information           in both the patient file and vendor file.  Responsible for submitting the PRC activity                     computer tape on a weekly basis.  Must have knowledge of the correct computer menu in             order to make proper changes.

Qualifications:

Must be detailed oriented and proficient with PC. Proficient with Microsoft office products, word and excel.

:

Employee must comply with all requirements and provisions of Subpart D, of 43 CFR, Part 2, which implements the Privacy Act (5USB, 552a) (i)(l).

Drug-Free Workplace Policy:

As a condition of employment, applicants must consent to pre-employment drug testing prior to appointment, and abide by the Drug-Free Workplace Policy while employed by the Kickapoo Tribe in Kansas.

Indian Preference:

Preference in filing vacancies is given to qualified Indian candidates in accordance with Indian Preference Act of 1934 (Title 25, USC, Section 472).  Verification must be submitted with the application if claiming Indian Preference.  Consideration will be given to non-Indian applicants in the absence of qualified Indian Preference eligible.