PRC Technician

Provides a full range of services related to contract health, business office, medical records, and clinic administration for the Purchased Referred Care (PRC) program.

Responsibilities include:

• Determine patient eligibility for PRC-covered care and apply PRC rules and regulations.
• Identify alternate resources such as Medicare, Medicaid, Veterans Administration, private insurance, and state programs.
• Serve as a liaison between patients, outside providers, and resource agencies regarding coverage and follow-up care.
• Assist with referrals, follow-up care, diagnostic procedures, and appointment scheduling.
• Instruct patients on medical preparation prior to treatment and notify appropriate personnel of appointments and documentation needs.
• Maintain health records, authorizations, eligibility forms, and privacy-related documentation.
• Review medical records for completeness, consistency, and compliance with requirements.
• Verify third-party insurance eligibility and maintain ongoing checks on patient coverage.
• Prepare release of information, assignment of benefits, and pre-certification documentation.
• Gather information for billing purposes and search medical records to support outpatient services and coding-related activities.
• Conduct daily interviews to obtain demographic and insurance information.
• Review incoming medical bills to determine whether approved referrals were made and prepare documentation for approval or denial.
• Enter PRC data, referral data, notification information, denial information, and other program data into computer systems.
• Provide technical PRC information, answer inquiries, and prepare correspondence and reports.
• Perform other related duties as assigned.