PRC Claims & Billing Specialist

Confederated Tribes of the Colville Reservation; Washington; On-site; USD 31,000 - 38,000; Full time

Job summary

Confederated Tribes of the Colville Reservation in Nespelem, WA is seeking a Claims Processing Specialist to ensure accurate and timely processing of PRC program claims. You will verify patient eligibility, adhere to federal PRC regulations, and maintain detailed claim records for audits.

The role requires knowledge of CPT, ICD-10, HCPCS coding and HIPAA, with the ability to work independently and alongside health service staff, providers, and vendors to coordinate benefits and reimbursements.

Qualifications

• High School Diploma or GED required.
• Associate’s degree in health administration, business, or related field preferred.
• Minimum of two years’ experience in medical billing, claims processing, or PRC services.
• Certification in medical billing or coding (CPC, CPB, CBCS) preferred.
• Valid Washington State driver’s license and insurable under Tribe policy.
• Experience with tribal health programs or IHS preferred.
• Proficiency in CPT, ICD-10, and HCPCS coding systems.

Responsibilities

• Process claims accurately and timely for the PRC program.
• Verify patient eligibility and ensure compliance with PRC regulations.
• Coordinate with providers and vendors; maintain detailed claim records for audits.
• Interpret and apply CPT/ICD-10/HCPCS coding in claims.
• Maintain confidentiality and comply with HIPAA regulations.

Skills

Medical billing

Claims processing

PRC regulations

HIPAA compliance

Analytical skills

Attention to detail

Communication skills

Independent work

Education

High School Diploma or GED

Associate’s degree in health administration or related field

Medical billing/coding certification (CPC, CPB, CBCS)

Tools

Electronic health records (EHR)

Medical billing software

CPT ICD-10 HCPCS coding tools

Job description

Confederated Tribes of the Colville Reservation in Nespelem, WA is seeking a Claims Processing Specialist to ensure accurate and timely processing of PRC program claims. You will verify patient eligibility, adhere to federal PRC regulations, and maintain detailed claim records for audits.

The role requires knowledge of CPT, ICD-10, HCPCS coding and HIPAA, with the ability to work independently and alongside health service staff, providers, and vendors to coordinate benefits and reimbursements.