Position Title
Contract Health Services Agent
Job Type
Full-Time
Classification
Non-Exempt
Grade
NE8 (13.49 - 18.88)
Department
Clinic Medical
Supervisor
Position Summary
Under direct supervision the Contract Health Services Agent is responsible for initiating medical authorizations and documents that are reviewed for patient information and clinical/fiscal data. Maintains confidentiality of all privileged information.-
High School Diploma or GED and two years experience in a medical office setting; or equivalent combination of education and experience.
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Must be able to successfully pass a pre-employment drug/alcohol screen and background investigation.
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Preference will be given to qualified Native American Indians.
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Determines patient eligibility for care under the Contract Health Services Program in accordance with the Code of Federal Regulations “42 CFR, Part 36 § 36.23”.
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Identifies and refers patients that are potentially eligible for alternate resources to the Benefits Coordinator.
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Educates patient on CHS eligibility requirements and program limitations.
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Determines the priority for services provided under the CHS Program based upon established IHS priority guidelines.
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Processes medical, mental health, optometry and dental referrals through RPMS/RCIS.
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Ensures patients are referred to providers within their PPO/HMO network and utilizes CHS contract providers.
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Commits CHS funds by processing purchase order in the CHS commitment register to ensure the accurate accountability of funds and proper fiscal coding procedures.
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Closely monitors CHS obligations and expenditures with the objective of keeping within the monthly budget allowance.
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Prepares denials based on applicable CHS regulations.
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Monitors activities and records pertaining to the fiscal management of CHS funds.
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Identifies and refers possible Catastrophic Health Emergency Fund “CHEF” and Third Party Liability Cases to the Fiscal Intermediary department.
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Notifies the provider as to alternate resource(s) available to the patient to enable the provider to submit the claim to the appropriate alternate resources.
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Reviews Emergency Room notification for CHS eligibility, notification requirements, priority and coordination of benefits and to estimate associated costs.
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Participates in Quality Assurance and Utilization Reviews during the CHS Managed Care Committee Meetings.
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Interfaces with in-house and outside providers to coordinate appointments.
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Interfaces with patients to discuss details of referral and coordinate appointments.
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Schedules patient appointments with outside providers.
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Coordinates transportation request with the transportation department.
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Ensures that pertinent medical information is forwarded to provider or facility prior to scheduled appointment.
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Maintains an efficient and effective filing system.
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Provides technical assistance to management.
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Explains and interprets regulations and policies to ensure appropriate use of CHS.
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Develops and implements CHS procedural guides, complies and interprets various alternate resources, references and guides.
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Answers telephone and personal inquiries regarding CHS eligibility.
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Compiles information and prepares for submission of periodic and special reports concerning CHS to the Business Office Manager.
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Performs other duties as required.
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Knowledge of modern office practices, procedures, and equipment.
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Knowledge of business English, proper spelling, grammar, punctuation, and basic arithmetic.
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Knowledge of records management and basic accounting procedures.
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Knowledge of various insurance benefits and contract health service requirements.
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Ability to listen intently and skill in working with Native Americans, their families and others.
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Ability to communicate effectively in the English language both verbally and in writing.
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Ability to establish and maintain professional relationships with individuals of varying social and cultural backgrounds and with co-workers at all levels.
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Ability to represent the organization in a professional manner, building respect and confidence.
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Ability to maintain confidentiality.
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Ability to handle multiple tasks and meet deadlines.
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Ability to carry out instructions furnished in verbal or written format.
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Ability to work independently with minimal supervision.
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Ability to demonstrate excellence in everything, and continually seek improvement in results.
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Skill in obtaining exact and precise information from in-depth interviews with Native American patients and other family members to determine possible eligibility for alternate resource funding(s).
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Skill in operating business computers and office machines, including in a Windows environment, specifically Word, Excel, Access, and presentation software (such as PowerPoint).
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While performing the duties of this job, the employee regularly is required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee frequently is required to walk. The employee occasionally is required to stand; and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds.
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Work is generally performed in an office setting with a moderate noise level.
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The Washoe Tribe of Nevada & California requires a background check of each new hire for employment purposes. Therefore, all conditionally offered positions will be subject to the following:
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Negative alcohol and drug screen
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Meet requirements of Public Law 101-630
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Obtain or possess a valid driver’s license for either the state of Nevada or California within 30 days
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Must be insurable under the Washoe Tribe’s driving policy