Purchased Referred Care (PRC) Coordinator

Job overview

The Purchased Referred Care (PRC) Coordinator role is onsite in Rapid City, SD, in an office or administrative setting. Compensation is listed as $24.20–$30.09 per year in the source. The position is part of the Oyate Health Center and reports to the Purchased Referred Care Manager. The coordinator initiates, tracks, and processes payer-of-last-resort health insurance claims under Contract Health Services guidelines. The role supports access to approved care by coordinating referrals, eligibility screening, appointments, claims, and reimbursements with clients, providers, and outside agencies.

What you'll do

• Maintain Contract Health Service files
• determine whether referrals meet approved priorities
• prepare and follow up on referrals requiring medical or dental review
• determine client eligibility and refer eligible clients to Alternate Resources for screening and application
• coordinate appointments with outside providers and create purchase orders for approved referrals
• communicate with clients, providers, and agencies about claims and case status
• track cases through appointments, procedures, eligibility determinations, and final payment
• track and submit reimbursements
• prepare Catastrophic Health Emergency Fund cases and notify the supervisor of possible pending cases
• respond to requests for PRC assistance
• comply with HIPAA and attend the weekly Managed Care Committee.

What we're looking for

Skills & competencies

purchased referred care coordinator

prc

contract health services

claims processing

referral coordination

eligibility screening

healthcare administration

hipaa

rapid city sd

great plains tribal leaders health

high school diploma

tribal preference

Work arrangement

• Weekend coverage required

Why this role

Requires a high school diploma or equivalent and three years of administrative support experience, including one year in purchased referred care. Tribal preference applies. Employment is contingent on required background checks, drug screening, and compliance with employee health screening and immunization requirements.

About the employer

Great Plains Tribal Leaders Health is hiring for this role. Industry: Home Health Care Services. Sector: 62.