Under the direct supervision of the Ak-Chin Indian Community Council, the Purchased/Referred Care (PRC) Manager is responsible for the oversight and administration of the PRC program which includes supervision of staff, budget development and accountability, and advocate for all eligible program users.
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Minimum Qualifications:
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Bachelors Degree in Business, Health Care Administration, Human Services or a closely related field and five (5) years experience working in a health care delivery system business office or closely related work, at least two (2) years of supervisory experience; OR any equivalent combination of experience and training that provides the knowledge and abilities necessary to perform the essential duties. Must have a valid Arizona Drivers License and be able to meet the Communitys insurance carrier requirements. Must successfully complete a background check.
Previous experience with a Tribally operated PRC program is highly desired
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Examples of Duties: |
- Responsible for all PRC program operations, functions and services guided by an adherence to program policies and procedures and manages the program that meet the Ak-Chin Indian Community mission, vision and values.
- Provides supervision and guidance to all PRC staff including scheduling, performance management, and providing training and opportunities for professional growth.
- Prepares programmatic, fiscal, and statistical reports and data as requested
- Works collaboratively with Tribal leadership and other Tribal/Community entities.
- Assists with determining provider agreement rates for PRC outpatient and inpatient services
- Ensures the processing of Medicare-Like rates for appropriate claims
- Develops the annual budget and closely monitors expenditures, variances and high cost/chronic care case management
- Provides guidance on day-to-day services including eligibility determination, maintaining billing and payment records, authorizing services, claims processing and identifying alternate resources
- Prepares CHEF claims in coordination with the PRC Specialist
- Ensures an office culture of respect, enthusiasm to assist program recipients, teamwork and positive attitudes; effectively and efficiently addresses staff and program recipient issues
- Maintains strict confidentiality, meets HIPAA compliance and IHS regulatory requirements as well as all other tribal, state or federal applicable regulations
- Performs other duties as assigned
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| Other Requirements: |
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- Knowledge of the culture, customs, and traditions of the Ak-Chin Indian Community
- Knowledge of medical terminology
- Knowledge of EOBs, CPT & ICD-10 codes, HCFAs, UB04s, HCPCS, and DRGs.
- Knowledge of third-party billing and claims processing procedures
- Knowledge of ICD 10 coding desired
- Knowledge of medical claims, Medicare/Medicaid guidelines
- Proficient in business administration.
- Skill in operating a Purchase/Referred Care Program, including program planning and budgeting.
- Skill in planning, coordinating, assigning, and reviewing the work of subordinate staff.
- Skill in team building and conflict resolution.
- Skill in preparing/presenting a variety of records, reports, grants, and proposals.
- Skill in dealing with sensitive, personal issues and maintaining appropriate professional, confidential relationships.
- Experience with billing software, Microsoft Office Excel proficiency and electronic records
- Excellent verbal and written communication skills.
- Strong track record of exemplary supervisory and program management skills, teamwork and staff/patient communications
- Strong skill in data entry and word processing
- Ability to maintain professionalism and a strict standard of confidentiality;
- Ability to work evenings, weekends, and to travel in-state and out-of-state, as needed
- Ability to establish and maintain effective working relationships with other employees, Community officials and the general public;
- Ability to perform all physical requirements of the position; agree to maintain a Drug-free workplace
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