PRC Claims Analyst, Purchased/Referred Care

United South and Eastern Tribes Inc.; Connecticut; Hybrid; USD 48,000 - 72,000; Full time

Job summary

United South and Eastern Tribes Inc. is seeking a PRC Claims Analyst for the Purchased/Referred Care program in Uncasville, CT. The role focuses on reviewing and processing requests for assistance, guided by IHS PRC protocols and payer policies.

The ideal candidate will have knowledge of ICD-10 and CPT coding, Medicare/Medicaid rules, strong Word/Excel skills, and a commitment to confidentiality and organization.

Qualifications

• High school diploma required.
• 3 years’ experience in medical coding or billing.
• 2 years’ experience with either EHR or electronic billing system.
• CPC and/or CPB certification preferred.
• 1 year of customer-facing or data-entry experience in a medical office.

Responsibilities

• Review, evaluate and process requests for assistance to the PRC program.
• Apply knowledge of PRC guidelines, ICD-10/CPT coding and payer policies.
• Maintain confidentiality and accurate records; work with EHR systems as needed.

Skills

IHS PRC knowledge

ICD-10 & CPT coding

Medicare/Medicaid policies

Word & Excel

Claims adjudication or EHR

Confidentiality

Organizational skills

Education

High school diploma

CPC

CPB

Tools

Microsoft Word

Microsoft Excel

EHR System

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

PRC Claims Analyst, Purchased/Referred Care

Full-Time Regular H.F.T. Uncasville, CT, US

Summary of Job Description:

Incumbent in this position reviews, evaluates and processes requests for assistance made to the Tribal Purchased/Referred Care program.

• Knowledge of IHS Purchased Referred Care Programs & Services or ability to learn
• Knowledge of medical terminology, ICD-10 and CPT coding
• Knowledge of Medicare, Medicaid and other payers’ reimbursement policies and procedures
• Intermediate Word and Excel skills (skill level determined by testing)
• Strong knowledge of claims adjudication or Electronic Health Record (EHR) systems
• Strong organizational skills
• Ability to maintain strict confidentiality

Education, Experience and Training:

• High school diploma
• Three (3) years’ experience in medical coding or billing
• Two (2) years’ experience with either Electronic Health Record (EHR) or electronic billing/payment system

~OR~

• High school diploma
• Certified Professional Coder (CPC) or Certified Professional Biller (CPB) or both
• One (1) year of experience in a customer-facing or data-entry role in any medical office setting

The Mohegan Tribal Government is committed to Native American Preference and is an Equal Opportunity Employer.