Billing Specialist

Health Pros North West; Skokomish (WA); On-site; USD 52,000 - 68,000; Full time

Job summary

Health Pros Northwest is seeking a Billing Specialist to support PRC eligibility, referrals, and medical billing for a Tribal Health Clinic in Skokomish, WA. This full-time, direct-hire role operates Monday through Friday 8am–5pm.

The candidate will handle PRC eligibility, referral coordination, claims review, EOBs, prior authorizations, and payment review while ensuring compliance with tribal, IHS, payer, state, and federal requirements.

Qualifications

• Two years PRC experience in a tribal health or IHS facility.
• Two years in medical office, clinic, hospital, or healthcare billing environment.
• Two years using an electronic health record and/or medical billing system.

Responsibilities

• Support PRC eligibility and referral coordination.
• Review claims and Explanation of Benefits (EOB).
• Navigate prior authorization processes and payment review.
• Perform medical billing tasks to ensure compliant, timely reimbursement.
• Coordinate with patients, providers, and insurance carriers to resolve issues.

Skills

PRC experience

Medical billing

EHR systems

ICD-10-CM coding

HIPAA compliance

Communication

Teamwork

Background checks

Drug screening

Education

Associate degree in Accounting or Health Info

Job description

Health Pros Northwest is seeking a Billing Specialist to assist with the local Tribal Health Clinic located in Skokomish, WA. This would be a full-time, direct hire position. The clinic's hours are Monday-Friday 8am to 5pm

NATURE OF WORK:

This is a dual role position responsible for Purchased Referred Care (PRC) and Medical Billing functions within the Health Department. The PRC program is funded and regulated through Indian Health Service (IHS) and is intended to supplement and complement other available healthcare resources for eligible participants. This position supports PRC eligibility, referral coordination, claims and Explanation of Benefits (EOB) review, prior authorization processes, payment review, and medical billing functions to ensure compliance with tribal, IHS, payer, state, and federal requirements while working closely with patients, providers, outside facilities, insurance carriers, and internal staff to support timely access to care, accurate claims processing, appropriate reimbursement, and compliance with payer of last resort requirements.

QUALIFICATIONS:

• 1. High school diploma or GED.
• 2. Minimum of two (2) years of experience working as a PRC Specialist in a tribal health or IHS facility.
• 3. Minimum of two (2) years of experience working in a medical office, clinic, hospital, or healthcare billing environment.
• 4. Minimum of two (2) years of experience using an electronic health record and/or medical billing system.
• 5. Working knowledge of insurance billing, claims processing, EOB review, prior authorization processes, and reimbursement practices.
• 6. Working knowledge of ICD-10-CM, HCPCS, and CPT coding.
• 7. Knowledge of HIPAA, confidentiality, and healthcare privacy requirements.
• 8. The candidate must have a valid driver’s license and be eligible for the Tribe’s automobile insurance.
• 9. Must be able to work in a team environment.
• 10. Strong organizational, communication and interpersonal skills preferred.
• 11. The selected candidate must successfully complete a pre-employment drug screen test, and a complete background investigation, including relevant criminal history, prior to employment.

PREFERRED QUALIFICATIONS:

• 1. Associate degree in Accounting, Medical Office Technology, Health Information, Business, or related field.
• 2. Experience using IHS-RPMS, CHS, RCIS, or related IHS/tribal health systems.
• 3. Medical billing and coding certification.
• 4. Accounts payable, payment processing, or healthcare finance experience.
• 5. Experience working with tribal health programs, third-party liability, Medicaid, Medicare, and commercial insurance.