CHS/PRC Claims Specialist - Tribal Health

Nisqually Indian Tribe; Olympia (WA); Vor Ort; USD 31.000 - 44.000; Vollzeit

Zusammenfassung

Nisqually Indian Tribe seeks a detail-oriented administrator to manage PRC/CHS workflow within the Health & Wellness Center. You will coordinate care, manage benefits, and approve services per IHS eligibility guidelines while delivering prompt financial processing and reporting for obligations.

The role involves extensive customer service, eligibility verification, and PO/EOB tasks within a tribal health setting, aligned with HIPAA rules.

Qualifikationen

• High school diploma or equivalent.
• Three years' experience in PRC/CHS or IHS tribal health services.
• Three years' experience processing health/dental claims.
• Two years in depth knowledge of benefits & claims processing.
• Two years successful customer service background.

Aufgaben

• Ensure that all Indian Health Contract Health Service requirements are met for all eligible clients/patients and assists in all necessary daily operations of the CHS program.
• Administer contracted health care to eligible clients/patients according to the IHS federal guidelines, and the programs Policy & procedures, as well as federal rules/regulations based on annual funding.
• Responsible for assuming dual responsibility for processing routine and complex health claims as well as providing customer service to both patients and providers.
• Serve as a resource for clients/community members and other Nisqually Tribal Health & Wellness Center staff.
• Conduct a majority of their workday with face to face and phone contact with PRC/CHS eligible clients issuing authorizations for medical care.
• Assists in assuring patient eligibility meets the IHS/PRC guidelines. Verifying all alternative medical insurance resources are utilized prior to providing PRC services.
• Generating Purchase Order numbers (PO) through the current PRC operating system, for patients requesting via telephone or in person.
• Matching Explanation of Benefits (EOB) to existing Purchase Orders (PO)
• Verify and document the status of each individual existing Purchase Orders (PO), for completion of the billing process, and to assure payments are made in a timely manner.
• Work with off-site Specialty Providers inquiring about referrals, and services related to physician visits, laboratories, pharmacies, dental providers, and patients via mail or in person.
• Works daily with invoicing of PRC/CHS claims, and the posting of payments.
• Provide answers to referring physicians, and those responsible for their billing, when inquiring about payment status.
• Open and sort incoming correspondence.
• Participates in seminars and meetings that relate to Purchase Referred Care/Contract Health Services.
• Filing and other common clerical duties.

Kenntnisse

Customer service

Communication skills

HIPAA confidentiality

Clerical duties

Ausbildung

High school diploma or equivalent

Three years experience in PRC/CHS or IHS tribal health services

Three years experience processing health/dental claims

Two years knowledge of benefits & claims processing

Two years customer service background

Tools

PRC operating system

Jobbeschreibung

Nisqually Indian Tribe seeks a detail-oriented administrator to manage PRC/CHS workflow within the Health & Wellness Center. You will coordinate care, manage benefits, and approve services per IHS eligibility guidelines while delivering prompt financial processing and reporting for obligations.

The role involves extensive customer service, eligibility verification, and PO/EOB tasks within a tribal health setting, aligned with HIPAA rules.