INSTRUCTIONS FOR APPLYING: Candidate must provide all information requested on the application page. Follow instructions carefully when preparing and uploading information. Please submit Resume and Cover Letter as PDF files only to ensure readability. All materials must be written in English. Resumes must include employment history with dates of employment and include details that show how you as a candidate satisfy the requirements of this position (degree, certifications, Alaska License Numbers, etc.).

Supervises: None

FLSA Status: Non-Exempt

Classification: Full-Time

Location: Homer

Schedule: Monday - Friday 40 hours per week/8 hours per day / 8am - 5pm.

Position Overview

The Patient Travel & PRC Referral Coordinator is responsible for coordinating all PRC patient referrals and follow-up, working closely with SVTHW medical staff, SVT PRC Administrator, referred-to care providers and patients. This position also serves as the primary contact for coordinating medically necessary travel authorization for all SVTHW patients.

Duties and Responsibilities

• PRC Referral Coordination:
  • Utilizing the electronic health record (EHR), review all referrals for PRC patients to determine patient’s health care payment and eligibility resources and choices. Educate and ensure the PRC patient has the information required to make an informed financial decision about where to receive their services (i.e. ANMC vs. local/private medical specialists).
  • Educate and assist patients with the authorization and referral process, referrals for specialty care or treatment, and additional clinical testing.
  • Coordinate PRC patient referrals with specialists, including but not limited to: obtaining insurance pre-authorizations necessary for the referral, sending relevant medical notes, demographics, and billing information to the specialist. Document all authorization correspondence in EHR.
  • Work with patient to alleviate barriers to following up with referrals, including assisting patient in scheduling appointments and making travel arrangements.
  • Maintain contact with PRC patient and referred-to care provider/facility regarding insurance and/or benefit conflicts.
  • Track patient appointments to completion. Obtain referral outcome/follow-up documentation and route back to ordering/referring provider to “close the loop” in patient care. Ensure patient’s follow-up care is complete.
  • Assist in developing, implementing, and updating policies and procedures related to PRC patient services and referrals.
  • Evaluate PRC referral metrics and performance by pulling daily, weekly, and monthly referral status reports for quality and utilization review.
  • Communicate with all members of the team and specialists regarding the PRC referral process to ensure proper coordination of care.
  • Monitor outstanding referrals sending reminder letters at the appropriate timeframe and sending cancellation letters once the referral is outdated (“stale”) as well as ensure appropriate communication about outdated referrals is carried out with referring provider.

• Travel Coordination:
  • Obtain prior authorization for Medicaid travel (composing letter of medical necessity, if required), for patients to attend medically necessary appointments at an SVTHW site and/or referring provider office. All requests must be in accordance with, and reviewed against, regulations governing Alaska State Medicaid Prior Authorization to verify eligibility for travel benefits.
  • Coordinate and book patient travel within the authorized parameters of the given Medicaid Travel Authorization, to include, but not limited to: air and ground transportation, lodging and meals, for patients and their escorts (if applicable). Must be able to determine medically necessary travel while ensuring patient appointments, travel arrangements, lodging, transportation and other logistical aspects of the patients’ medical travel are completed.
  • Work collaboratively with the ANMC Travel Management Office to assist, and be a point of contact/conduit for, local AI/AN patients to obtain travel documentation for services to be received at an ANMC location.

Qualifications

• Skill in working independently and as a team member.
• Skill in establishing and maintaining cooperative working relationships with others.
• Ability to work with patients who are in distress and problem solve in a calm, professional manner.
• Strong computer and communication skills are a must.
• Strong attention to detail and concern for completing task correctly and efficiently.
• Ability to prioritize responsibilities according to urgency and importance.
• Maintains a professional positive attitude at all times.
• Proficient in medical terminology.

Job Requirements

Education

• High School Diploma or equivalent required; Associates degree preferred

Computer Experience:

• Proficiency in Microsoft Office (Word, Excel, PowerPoint) and Outlook
• Proficiency with scheduling / insurance verification software

Experience

• At least 2-year experience with medical referrals and prior-authorizations (highly preferred in Outpatient Therapy) is required
  
• Healthcare Relevant: 2 years Preferred
• Minimum of 1-year experience in medical field preferred - service delivery (referrals, claims, insurance, billing, etc.) Preferred
• PRC Referral Coordinator: 1 Year Preferred

Certifications/Licensure

• None

Travel Requirements: None

Pre-employment Screening Requirements: FBI Fingerprinting, Pre-employment Drug Test, Pre-employment Background Screening

Physical Demands

N – Not Applicable: Activity is not applicable to this position

O – Occasionally: Position requires activity up to 33% of the time (0-2.5+ Hrs/Day)

F – Frequently: Position requires activity from 33% - 66% of the time (2.5 – 5.5+ Hrs/Day)

C – Constantly: Position requires activity more than 66% of the time (5.5+ Hrs/Day)

Activity

Stand - F

Walk - F

Sit - F

Climb - N

Crawl - N

Squat or Kneel - O

Bend - P

Speak - F

Grasp - O

Manually Manipulate - F

Reach Outward and Above – O

Lift/Carry

10 lbs or less - C

11-20 lbs – O

21 – 50 lbs - O

51- 100 lbs – N

Over 100 lbs – N

Push/Pull

12 lbs or less – C

13 – 25 lbs – O

26 – 40 lbs – N

41 – 100 lbs - N

Care Team

SVT Health & Wellness Care Teams partner with patients to provide the care they want and need. The Care Team works together and with the patient to ensure patients receive follow-up care, annual well exams and indicated preventative care and screenings. Members of the Care Team support each other to provide patient care and essential follow up. Our Care Team is comprised of the following positions. The involvement of team members varies depending on each patient’s need during any particular episode of care.

• Patient/Client
• Primary Care Clinicians
• Medical Assistants
• RN Care Coordinators
• Care Coordination Assistants
• Patient Services Representatives
• Behavioral Health Consultant
• Health & Wellness Coach

Work Environment

Seldovia Village Tribe is a drug-free, alcohol-free, and tobacco-free work environment. An individual in this position may be exposed to communicable diseases or hazards common to a healthcare setting, including but not limited to needle stick wounds, chemicals, and tuberculosis. Work will be conducted in a typical clinic setting.