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

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