Summary

Come join a company that strives for Extraordinary People and Exceptional Performance ! Chenega Government Mission Solutions, LLC, a Chenega Professional Services ’ company, is looking for a Medical Assistant in support of Indian Health Services in Claremore, OK. The Medical Assistant will provide support and technical assistance to the department including medical, surgical, hospital and clinical services to all eligible beneficiaries in conjunction with or in lieu of IHS facilities. In accordance with written policies, procedures, and regulations, the PRC program provides health care to all members of federally recognized Indian tribes living within the boundaries of PRC service delivery area.

Our company offers employees the opportunity to join a team where there is a robust employee benefits program, management engagement, quality leadership, an atmosphere of teamwork, recognition for performance, and promotion opportunities. We actively strive to channel our highly engaged employee’s knowledge, critical thinking, innovative solutions for our clients.

Responsibilities

• Verify patient eligibility in receiving routine medical referrals and/or emergency call-ins for treatment rendered by reviewing documentation in the patient registration regarding eligibility and alternate resources

• Maintain and utilizes the Resource Patient Management System (RPMS), Electronic Health Record (EHR) and the Referred Care Information System (RCIS) in reviewing documentation.

• Coordinate the management of the health care delivery system by providing contract medical vendors with CHS authorizations to determine an estimated cost of the services rendered, whether inpatient or outpatient services.

• Coordinate and provide patient education regarding the PRC program and associated requirements for eligibility.

• Interview and evaluate patients for possible eligibility of an alternate resource, ie. Medicare, Medicaid, Veteran's Administration, and other private insurance carriers.

• Ensure patients are referred to the Patient Benefit Coordinator for further assistance.

• Implement decisions made for the provision or denial of services.

• Coordinate the denial and/or deferred services on all medical referrals and informs the healthcare provider of the status of each referral within the PRC program.

• Prepare and distribute all authorizations, follow up letters on outstanding purchases, and denial and/or deferred letters to the patients and contract medical providers regarding services rendered.

• Interpret medical bills and explanation of benefits received from patients and medical providers.

• Review all incoming correspondence from providers.

• Determine if an authorization has been issued or has been paid using own initiative and judgment.

• Provide accurate health insurance information to providers by verifying the insurer's covered services to ensure no delay of payments.

• Schedule all patient appointments for Purchased/Referred Care and ensure proper follow up with the vendor to ensure patient’s care is coordinated in a seamless fashion.

• Provide coordination efforts of patient inquires, both in person and via phone, and ensures each inquiry is answered in a timely and customer service friendly approach.

• Ensure patients are informed on the priorities for services based on policy and procedure of the Claremore Indian Hospital Purchased/Referred Care program.

• Maintain the files of completed authorizations for hospitalizations, outpatient services and updates pending patient files with documented status of all written and verbal transactions.

• Assist in the reconciliation of the current Purchased/Referred Care budget.

• Assist in the preparation, submission, and payment processes of purchase orders for services rendered.

• Audit claims processed for third party resources and proper coding.

• Utilize knowledge in the maintenance of the Document Control Register (DCR).

• Referring/answering calls and questions

• Assemble PRC referrals in their required order and sequence for Alpha letter distribution

• Retrieve a variety of physicians’ orders for patient activities, diets, tests, and treatments

• Research/refer patients to appropriate clinics for care

• Answer questions regarding routine procedures

• Relay instructions to patients on referred care decisions

• File referred care results and distribute to appropriate staff for purchase order (PO) assignment

• Relay information regarding the patient’s referral status

• Compile and submit data on referred care and treatment plans

• Other duties and assignment when called upon by the PRC Management Staff.

Qualifications

• Qualified typist

• 1 year of experience in a medical office

• Proficient with MS Office Suite

Knowledge, Skills and Abilities:

• Referring/answering calls and questions

• Excellent written and oral communication skills

• Knowledge of Medical procedures, various medical specialties, and medical terminology

Chenega Corporation and family of companies is an EOE.

Equal Opportunity Employer/Veterans/Disabled

Native preference under PL 93-638.

We participate in the E-Verify Employment Verification Program