{"id":1433261,"url":"https://alion.io/job/aaipdocs-purchased-referred-care-prc-coordinator","title":"Purchased Referred Care (PRC) Coordinator","company":{"id":1857029,"name":"aaipdocs","domain":"aaip.org","url":"https://alion.io/company/aaip","size_band":null,"is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"ADP","truth_index":null},"role":"Administrative","role_family":"Administrative","seniority":"middle","employment_type":"full_time","work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"explicit","locations":["Rapid City, United States"],"countries":["US"],"hiring_countries":[],"hiring_countries_total":0,"salary":null,"salary_estimate":{"min_usd":35000,"max_usd":66000,"period":"year","method":"role_seniority_country_remote_cell","sample_n":1977},"experience_years_min":3,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"HIPAA","optional":false}],"status":"live","first_seen_at":"2026-09-28T17:29:00Z","employer_posted_date":"2026-09-28","last_verified_at":"2026-10-22T21:48:22Z","board_verified":true,"closed_at":null,"days_open":24,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":24},"description":"Purchased.Referred.Care.(PRC)Coordinator.fy26.docx\nPosition Title: Purchase Referred Care Coordinator\nDivision: Oyate Health Center\nReports To: Purchased Referred Care Manager\nJob Summary:\nThis position is responsible for initiating, tracking, and processing “payer of last resort” health insurance claims\naccording to United Indian Health Services (UIHS) Contract Health Services (CHS) guidelines. It requires a\nthorough knowledge of: Purchased Referred Care services and alternate resources, that may include but is not\nlimited to private insurance, and Medicare/Medicaid programs; knowledge of alternate resources including the\nAffordable Care Act (ACA); knowledge of funds control techniques to account for the funds allotted for the\nPurchased/Referred Care services; and knowledge of specialized medical terminology that may include diagnosis\nand procedural terms.\nSpecific duties include, but are not limited to:\nMaintains Contract Health Service files. \nDetermines if incoming Contract Health Services referrals are within the UIHS approved priorities. \nPrepare and follow up on Contract Health Services referrals that need medical and dental review. \nDetermines if clients meet eligibility requirements, including referral to Alternate Resources for screening\nand application if eligible.\nContact outside providers to set up appointments for approved cases, ask for an estimate of charges, and\nnotify clients of scheduled appointments. Create purchase orders for eligible approved referrals.\nCommunicates and corresponds with outside agencies and clients regarding claim submission. \nCommunicates and corresponds with clients/providers regarding status of Contract Health Services claims. \nCommunicates and corresponds with UIHS providers to clarify Contract Health Services referrals and\naddress case status questions.\nTracks Contract Health Services cases through the processes of appointment, procedural scheduling,\noutcome, third party insurance eligibility determination, and final claims payment processing.\nTracks and submits claim reimbursements through Contract Health Services. \nPrepare and submit Catastrophic Health Emergency Fund (CHEF) cases following guidelines from IHS.\nNotify supervisor of possible pending CHEF cases so they can be reported to the Patient Registration/ Contract Health Services committee. \nResponds to inquiries and requests for PRC services assistance via telephone, written communication, or personal visit. Coordinates these requests and provides consultation to resolve problems or issues. These requests in many instances originate from a variety of sources requiring contact with outside agencies and organizations.\nMust comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA).\nPerforms related duties.\nPerforms the core responsibilities of the position accurately, timely, and in accordance with established standards.\nMaintains regular and reliable attendance consistent with the position’s schedule and operational needs.\nCommunicates effectively with internal and external stakeholders as required by the role.\nAdheres to all applicable policies, procedures, and regulatory requirements.\nUtilizes required systems, tools, and technology necessary to perform the job.\nAttends the Managed Care Committee on a weekly basis. \nMinimum Qualifications\nHigh school diploma or equivalent.\nThree (3) years of administrative support experience, including one (1) year of experience working in purchased referred care, sufficient to understand and perform the major duties of the position, and to be able to answer questions and resolve problems. Experience in a health care business office, medical insurance office, social services agency or customer services position is preferred. \nMust successfully pass a criminal and background check, and a pre-employment drug screen.\nThe GPTCHB is a tribal organization which follows tribal preference laws. It is our policy to give preference to qualified Indian/Tribal candidates over a qualified non-native candidate in hiring decisions, if all other qualifications are equal.\nEmployment is contingent upon the outcome of all required criminal background checks and pre-employment drug screen.\nCompliance with our Employee Health Procedure is a condition of employment. You are required to agree that you will comply with all job-related employee health screening and immunizations prior to your first day of employment. Jobs require that you have documentation that you have completed the following immunizations prior to your first day of employment: MMR (Measles, Mumps and Rubella, Varicella (Chicken Pox), Hepatitis B, Influenza, T-dap (Tetanus - Diphtheria - Pertussis), and COVID-19 vaccination is required.\nThis position requires the ability to perform the essential functions of the job, with or without reasonable accommodation. Physical demands and work environment may include:\nPrimarily sedentary work is performed in an office or administrative setting.\nRequires the ability to sit for extended periods and regularly use standard office equipment such as a computer, keyboard, telephone, and copier.\nOccasional standing, walking, bending, and reaching may be required.\nAbility to lift and carry office materials or supplies up to 25 pounds occasionally.\nRequires manual dexterity and visual acuity for computer use and document review.\nMust be able to read, write, speak, and hear.\nWork is performed primarily in an indoor office or administrative environment.\nThe environment involves everyday risks or discomforts that require normal safety precautions typical of office settings, including proper use of office equipment and awareness of trips, falls, and fire regulations.\nThe work area is adequately lighted, heated, and ventilated.\nMinimal exposure to hazardous conditions; no routine exposure to clinical, field, or high risk environments.\nOccasional attendance at meetings, training sessions, or events may require travel within the organization's facilities.\nThe employee must comply with all organizational policies, procedures, and applicable laws and regulations. This position is subject to Native Preference, background checks, health requirements, and other applicable organizational standards.","description_format":"text","description_chars":6274,"description_truncated":false,"requirements":{"experience_years_min":3,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"high_school","optional":true},"security_clearance":false,"languages":[]},"benefits":["Health insurance"],"hiring_locations":[{"name":"China","iso":"CN","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Health Care","Health Insurance & Benefits"],"lifecycle":[{"event":"open","at":"2026-09-29T02:08:15Z"}],"visa":[],"liveness":{"score":27,"band":"fade","label":"Fading","p_open":1,"p_active":0.594,"p_room":0.45,"age_days":23,"expected_fill_days":14,"reasons":["conf:10","win:tail"],"computed_at":"2026-10-22T06:10:10Z"},"pay":null,"html_url":"https://alion.io/job/aaipdocs-purchased-referred-care-prc-coordinator","json_url":"https://alion.io/job/aaipdocs-purchased-referred-care-prc-coordinator.json","meta":{"generated_at":"2026-10-22T22:20:30Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":7461,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-23T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":1857029},"rest":"https://alion.io/mcp/rest/get_company?id=1857029"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Faaipdocs-purchased-referred-care-prc-coordinator"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Faaipdocs-purchased-referred-care-prc-coordinator"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Faaipdocs-purchased-referred-care-prc-coordinator"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/aaipdocs-purchased-referred-care-prc-coordinator\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Faaipdocs-purchased-referred-care-prc-coordinator"}]}