×

HOW TO SHOP

1 Login or create new account.
2 Review your order.
3 Payment & FREE shipment

If you still have problems, please let us know, by sending an email to support@website.com . Thank you!

SHOWROOM HOURS

Mon-Fri 9:00AM - 6:00AM
Sat - 9:00AM-5:00PM
Sundays by appointment only!

HUMAN RESOURCES & JOB OPPORTUNITIES

Welcome to the Confederated Tribes of the Coos, Lower Umpqua and Siuslaw Indians' (CTCLUSI) Job Opportunities page.

(CTCLUSI TRIBAL MEMBERS ONLY)

Jobs available in our Tribal Government and other Tribal Entities

Thank you for your interest in employment with CTCLUSI. We employ a broad range of qualified applicants with experience for positions at our different locations.

Jobs available in our Tribal Government and other Tribal Entities are as follows:

  • Blue Earth - Full Service Voice & Data Network Interconnect Company and Other Enterprises
  • CTCLUSI - Tribal Government Offices
  • TRCR - Three Rivers Casino Resort (Florence and Coos Bay)

HR Recruitment
recruitment@ctclusihr.org
Monday - Friday
8am - 5pm 
541-888-7523

For additional information

Purchased Referred Care Specialist

    • Job Tracking ID: 512409-790425
    • Job Location: Coos Bay, OR
    • Job Level: Mid Career (2+ years)
    • Level of Education: Any
    • Date Updated: September 17, 2021
    • Years of Experience: 2 - 5 Years
    • Starting Date: ASAP
    • Close Date: Open Until Filled
    • Job Type: Full Time
    • Starting Salary: $18.14/hr. DOE
Invite a friend
facebook LinkedIn Twitter Email


Job Description:

SUMMARY

Responsible for processing Purchased/Referred Care (PRC) claims, Tribal member registration, purchase orders, letters of notification, and other duties as assigned.

PRINCIPAL ACTIVITIES & RESPONSIBILITIES

  • Provide PRC duties which include, but are not limited to, verifying applicant residency, auditing payment claims, repricing claims, identifying alternate resources, maintaining payment records, identifying claims paid when requested by providers, and providing billing and authorization procedures/requirements to providers.
  • Provide telephone customer service for Tribal members to access Purchase Orders and other PRC services.
  • Manage applications for the PRC program. Review applications for completeness, collect eligibility information and enter pertinent data into RPMS to issue authorizations.
  • Assist Tribal members with alternate resources/insurance (Marketplace, Medicare, OHP, etc.) applications and interpret alternate resource requirements to Tribal members and providers.
  • Track and maintain records of limited benefit usage and Medicare reimbursements.
  • Process letters for deferred and denied requests for services and other correspondence with Tribal Members.
  • Accept and process prior authorizations for treatment from primary care providers.
  • Work with our Pharmacy Benefits Manager (PBM) to process pharmacy claims. Work with pharmacies to ensure appropriate management of pharmacy claims.
  • Input new Tribal Dental Clinic patients into the RPMS Patient Registration as needed.
  • Establish and maintain patient and general file system.
  • Run monthly RPMS reports and distribute as assigned.
  • Develop and maintain relationships with various health providers and vendors, as well as Tribal Enrollment office.
  • Attend trainings, classes and seminars to remain current on relevant issues as needed.
  • Maintain appearance standards as outlined in CTCLUSI policies.
  • Interact with Tribal members and the public in a courteous, professional, friendly, helpful and efficient manner.
  • Communicate effectively both verbally and in writing.
  • Maintain a good attendance record.
  • Other duties as directed by management.

PHYSICAL & MENTAL DEMANDS

  • Must be able to walk, talk, hear, use hands to handle, feel or operate objects, tools, or controls, and reach with hands and arms.
  • Vision abilities required by this job include close vision and the ability to adjust focus.
  • May be required to push, pull, lift, and/or carry up to 40 pounds.

WORKING CONDITIONS & ENVIRONMENT

  • Moderate noise level with frequent interruptions and distractions.

HOURS

  • 40 hours per week.
  • Generally Monday through Friday 8am to 5pm with possible occasional evening and weekend work.

JOB LOCATION

Tribal Administrative Office
1245 Fulton Avenue
Coos Bay, Oregon 97420

Experience and Skills:

MINIMUM JOB REQUIREMENTS

  • Must be at least 18 years of age.
  • Associates Degree in Medical Accounting / Medical Accounts Payable with two or more years of experience post education OR any combination of education, experience and training which must include medical billing.
  • Recent experience in Purchased and Referred Care (Contract Health), RPMS, Oregon Health Plan, private insurance, Medicare, Marketplace, claims, third party reimbursements, or provider offices preferred.
  • Working understanding of CPT codes, ICD-9/10 codes and medical terminology.
  • Excellent customer service skills required.
  • Demonstrated computer proficiency, including MS Word, Excel and Outlook.
  • Must be able to pass a computer test.
  • Must have experience and ability to multi-task.
  • Must be able to work with local, state and federal health agencies required.
  • Must possess reasonable ability to communicate in English.
  • This position is subject to pre-employment drug testing.
  • This is a covered position which requires background check that includes fingerprinting.
  • Must have employment eligibility in the U.S.
  • Indian preference will be observed in the hiring process.

Employee Benefits

To view and apply for Three Rives Casino Resort (Florence and Coos Bay), click on the following link: Three Rivers Casino Careers
Available to ALL Team Members, such as

  • Competitive wages & advancement opportunities
  • 401(k) Deferred Compensation Plan
  • Workers’ Compensation Insurance Program
  • Professional uniforms (if required) - FREE
  • Monthly Team Member appreciation events
  • Orientation, including Guest Service Training
  • Employee Assistance Programs (EAP) - FREE to TMs and eligible dependents
  • Team Member break areas with free beverages and computer access. Coos Bay has a dining area with access to discounted shift meals; Florence has a dining area with free salad and soup and access to discounted shift meals.
  • Special prices and/or discounts on work shoes through Shoes for Crews
  • Wellness Fair activities
  • Payroll Direct Deposit
  • 24/7 internet access to your payroll records and Team Member informational documents and resources through Paylocity
  • Discounts at TRC Hotel, Gift Shop, Restaurants & Ocean Dunes Golf Course. Please ask each venue for discount availability prior to your visit.
  • Discounts and/or specials at Coastal Fitness, Oil Can Henry’s, On Your Feet with a Splash (Florence), CDW, Ferrallgas, Oregon Pacific Bank, AT&T and other community-wide merchants as they become available.

Additional Benefits for Team Members who meet Eligibility Requirements, such as

  • Health Insurance via the FEHB & access to Dental, Vision & FSA
  • Life Insurance, Short-Term & Long-Term Disability Income Protection
  • Personal Time Off accruals (aka PTO) for use as needed for vacation, sick time, and/or personal time off
  • FMLA, Medical, Personal, Bereavement & Jury Duty Leave
  • Team Member Recognition Programs
  • Training & Development

Team Members are invited to participate in TRC established committees that meet regularly. Check the bulletin boards for more information. For more information on the benefits listed above, check Paylocity or stop by Human Resources ~ M-F 8am to 5pm

Available to ALL Employees, such as

  • Competitive wages & advancement opportunities
  • 401(k) Deferred Compensation Plan
  • Workers’ Compensation Insurance Program
  • Employee appreciation events
  • Employee Assistance Program (EAP) - FREE to staff and eligible dependents
  • Special prices and/or discounts on work shoes through Shoes for Crews
  • Wellness Fair activities
  • Payroll Direct Deposit
  • 24/7 internet access to your payroll records and Team Member informational documents and resources through Paylocity
  • Discounts at Three Rivers Casino Resort hotel, gift shop, restaurants & Ocean Dunes Golf Course. Please ask each venue for discount availability prior to your visit.
  • Discounts and/or specials at Coastal Fitness, Oil Can Henry’s, On Your Feet with a Splash (Florence), CDW, Ferrallgas, Oregon Pacific Bank, AT&T and other community-wide merchants as they become available.

Additional Benefits for Employees who meet Eligibility Requirements, such as

  • Health Insurance via the FEHB & access to Dental, Vision & FSA
  • Life Insurance, Short-Term & Long-Term Disability Income Protection
  • Paid Holidays
  • PTO ~ Paid time off accruals for personal time off and sick leave
  • FMLA, Personal, Bereavement & Jury Duty Leave

For more information on the benefits listed above, check Paylocity or contact Human Resources ~ M-F 8am to 5pm.

TOP