PRC Claims Analyst, Purchased/Referred Care

Mohegan Sun, Inc.; Connecticut; Hybrid; USD 55,000 - 75,000; Full time

Job summary

Mohegan Sun, Inc. in Uncasville, CT is seeking a PRC Claims Analyst to support the Purchased/Referred Care program.

The role reviews, evaluates and processes requests for assistance, leveraging IHS PRC knowledge, medical terminology, ICD-10/CPT coding and payer policies to determine eligibility and reimbursement. The ideal candidate has a high school diploma, 3 years of medical coding or billing experience (or CPC/CPB certification with 1 year customer-facing data-entry work), solid Word/Excel

Qualifications

• 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.

Responsibilities

• Review, evaluate and process requests for assistance to the Tribal Purchased/Referred Care program.
• Work with payers to determine eligibility and reimbursement.
• Maintain accurate records and ensure compliance with privacy regulations.

Skills

IHS PRC knowledge

Medical terminology ICD-10 CPT

Medicare/Medicaid payer policies

Word & Excel skills

EHR/claims adjudication systems

Organizational skills

Confidentiality

Education

High school diploma

CPC or CPB certification

CPC and CPB both

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.