Contact Representative

Serves as a Contact Representative in Purchased Referred Care administering eligibility determinations in accordance with federal regulations and IHS policy. Conducts detailed interviews with patients and families to verify eligibility for PRC and alternate resources such as Medicare, Medicaid, VA, and private insurance. Issues medical authorizations or denial letters, ensures funds availability prior to obligation, and maintains fiscal controls in compliance with federal requirements. Researches complex cases, interprets regulations, prepares reports, and serves as liaison with providers, tribal entities, and federal, state, and local agencies to ensure continuity of care and appropriate use of funds.