Overview Responsibilities include establishing, implementing, maintaining, and evaluating the Referred Care Services program for the assigned area including making referrals, setting up appointments with vendors, and processing required paperwork.

Patient education regarding RCS processes and policies. Qualifications EDUCATIONAL REQUIREMENT One-year certificate from college or technical school;

or 1-1 / 2 years of related experience; or an equivalent combination of education and experience. EXPERIENCE REQUIREMENT At least three (3) years of experience in a related field.

COMPUTER SKILLS An individual should know database software, internet software, spreadsheet software, and word processing software CERTIFICATES, LICENSES, REGISTRATIONS Completion of health-related courses or the study of medical terminology is preferred.

OTHER QUALIFICATIONS The employee must not be and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG's Cumulative Sanction Report, or the GSA's List of Excluded Providers, or listed on the OIG's List of Excluded Individuals / Entities (LEIE).

PHYSICAL DEMANDS While performing the duties of this Job, the employee is regularly required to use hands to finger, handle or feel, and talk or hear.

The employee is frequently required to sit and reach with hands and arms. The employee is occasionally required to stand, walk, climb or balance, and stoop, kneel, crouch, or crawl.

The employee must occasionally lift and / or move up to 10 pounds. Specific vision abilities required by this job include close vision, distant vision, color vision, peripheral vision, depth perception, and the ability to correct / adjust focus.

WORK ENVIRONMENT While performing the duties of this job, the employee may occasionally be exposed to fumes or airborne particles.

The noise level in the work environment is usually moderate.

Establishes, implements maintains and evaluates the Referred Care Services program for the assigned area. Makes recommendations and state concerns to the rural health center Referred Care Services Supervisor and Manager where applicable.

Develops and administers the purchased patient services for the facility by working closely with clinicians and processing referrals.

Schedules appointments for the patient with the vendor and gathers information that will be needed by the patient and vendor.

Notifies appropriate personnel of vendor costs above the normal fee range. Maintains filing as required. Verifies patient eligibility and makes notifications of denials.

Educates patients regarding Referred Care Services processes and policies. Coordinates and utilizes third-party resources for patient care services provided outside the rural health center.

Refers uninsured patients to the Patient Benefit Coordinators for evaluation of resources for which patients could be eligible at low or no cost.

Manages the automated RPMS manage care system and related databases by transferring data between the two databases. Processes vendor invoices by submitting them to the Referred Care payables as required.

Maintains a vendor list, which identifies private vendors and services provided. Notifies patients and providers when a chosen vendor is not in-network.

Makes reports as required. Monitors expenses closely and keeps appropriate personnel up to date. Other duties may be assigned.

SUPERVISORY RESPONSIBILITIES No supervisory responsibility

EXPERIENCE REQUIREMENT At least three (3) years of experience in a related field. COMPUTER SKILLS An individual should know database software, internet software, spreadsheet software, and word processing software CERTIFICATES, LICENSES, REGISTRATIONS Completion of health-related courses or the study of medical terminology is preferred.

OTHER QUALIFICATIONS The employee must not be and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG's Cumulative Sanction Report, or the GSA's List of Excluded Providers, or listed on the OIG's List of Excluded Individuals / Entities (LEIE).

PHYSICAL DEMANDS While performing the duties of this Job, the employee is regularly required to use hands to finger, handle or feel, and talk or hear.

The employee is frequently required to sit and reach with hands and arms. The employee is occasionally required to stand, walk, climb or balance, and stoop, kneel, crouch, or crawl.

The employee must occasionally lift and / or move up to 10 pounds. Specific vision abilities required by this job include close vision, distant vision, color vision, peripheral vision, depth perception, and the ability to correct / adjust focus.

WORK ENVIRONMENT While performing the duties of this job, the employee may occasionally be exposed to fumes or airborne particles.

The noise level in the work environment is usually moderate.

Last updated : 2024-04-23