General Clerk II

Koniag Advisory Business Solutions, LLC is seeking a General Clerk II to support the Purchased Referred Care (PRC) program within the Billings Area Indian Health Service (BAIHS). The successful candidate will provide advanced administrative support and play a critical role in ensuring patients receive appropriate healthcare coverage and authorization.

Requirements

• Determine patient eligibility, scope of benefits, and priority levels for the PRC program
• Review and analyze patient applications and supporting documentation
• Apply PRC program guidelines and regulations to make eligibility determinations
• Maintain comprehensive follow-up systems for Contract Health Services (CHS) patient files
• Track patient cases from initial application through completion of services
• Ensure timely processing of referrals and authorizations
• Monitor case progress and coordinate necessary follow-up actions
• Ensure proper allocation of funds for patient referrals, emergency call-ins, and follow-up care
• Monitor budget constraints and funding availability for PRC services
• Enter and verify authorizations, payments, cancellations, and supplements in PRC computer systems
• Maintain accurate financial records and documentation
• Process payment authorizations and modifications as required
• Utilize PRC information systems for data entry, retrieval, and reporting
• Maintain accurate and up-to-date patient records in electronic systems
• Generate reports and track program metrics as needed
• Ensure data integrity and security compliance

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• 401K with company matching
• Paid holidays
• Paid Vacation
• Paid sick leave