Provides routine clerical and administrative functions such as drafting correspondence, scheduling appointments, organizing and maintaining paper and electronic files, and providing excellent customer service to clients and vendors in the course of performing functions pertaining to the PRC Division.
Answers and responds to inquiries, routes telephone calls appropriately, provides excellent customer services over the phone, and takes messages when required;
Operates office equipment such as fax machines, copiers, phone systems, able to perform data entry and work with Microsoft applications, Word, and Excel;
Manages internal and external mail distribution, provides correspondence such as memos and letters and ensure attachments of supporting documents for external replies, when required;
Manages scheduling templates, and schedules and coordinates PRC client appointments;
Maintains PRC office supply inventory;
Responds to request for medical claim status;
Utilizes RPMS to verify Purchased Referred Care eligibility status and provide authorization for medical and pharmaceutical providers in accordance with PRC procedures;
Prepares and distributes Denial letters;
Assist with PRC identification card updates;
Provides tutorial for new enrollees on PRC requirements and procedures;
Request Medical Records as necessary to process claims;
Updates patients’ records as necessary;
Participates in Disaster Emergency Preparedness training and utilizes training upon declaration of a disaster by Tribal Council;
Cross-trains in other PRC positions to provide support when needed or assigned;
Participates in community outreach and education;
Performs other duties as assigned.
High School Diploma or its equivalent (GED); One-year certificate from college or technical school; or 3-5 years of related clerical experience and/or training; or equivalent education and experience. Bi-lingual – English/Spanish. Must possess a valid Texas Driver’s License and be insurable; must be able to successfully pass a post-offer drug screen and a background check;
KNOWLEDGE, SKILLS, AND ABILITIES:
Knowledge of administrative and office procedures and systems such as word processing, managing files and records, designing forms, and workplace terminology; Knowledge of the Affordable Care Act; Experienced in Microsoft Office applications and familiar with database software such as Excel and Access; possess excellent telephone etiquette; typing and filing accuracy. Must be able to deal empathetically with the community and learn the basic operating practices of Tribal health care and private insurance claims procedures. Must possess excellent communication and time management skills; Able to work in a fast-paced environment that requires multi-tasking and excellent customer service skills; well versed in HIPAA rules and procedures; Must always maintain confidentiality and be culturally sensitive to minority (especially Native American) populations.
While performing the essential functions of this position, the employee is frequently required to sit, talk, and listen. The employee is occasionally required to reach with hands and arms. The employee is occasionally required to lift to 10 pounds. The vision requirements include close vision, peripheral vision, and ability to adjust focus.
This description is a summary of principle responsibilities and is not intended to include all duties which may be assigned.
