PRC Claims & Financial Administrator

Yerington Paiute Tribe; Yerington (NV); On-site; USD 42,000 - 62,000; Full time

Job summary

The Yerington Paiute Tribe is seeking a qualified Billing/Accounts Payable specialist to maintain the fiscal integrity of the PRC program and ensure timely processing of claims, in accordance with clinic policy. The role involves preparing PRC claims and purchase orders, reviewing medical claims with insurers, and re-pricing according to Medicare/Medicaid/MediCal schedules.

Requires associate degree or 3+ years in related field, EMR proficiency, and strong attention to detail.

Qualifications

• Associate degree in Health Care Administration or Business Administration OR 3+ years in accounts payable/insurance billing.
• Knowledge of PRC rules and regulations is preferred.
• Proficiency in medical terminology and medical coding is strongly preferred.

Responsibilities

• Prepares PRC claims and Purchase Orders to Tribal Finance for payment.
• Reviews medical claims and insurance benefit statements for accuracy and communicates with vendors/insurers.
• Re-prices medical claims according to the Medicare/Medicaid/MediCal fee schedule.
• Reconcile checks against claims paid and prepare for mailing.
• Maintains accurate and complete patient claim files.
• Documents each step of referral and payment process in clinic’s electronic medical records system.
• Complies with the Clinic’s PRC priority level, policies and procedures.
• Notifies patients of PRC denials and processes patient appeals for review by PRC committee.
• Negotiates beneficial rate quote agreements with hospitals and specialty providers.
• Maintains current files of all agreements.
• Acts as primary point of contact for PRC providers and PRC patients.
• Mediates with third party insurance carriers for prompt payment.
• Adheres to HIPAA regulations confidentiality standards.
• Performs other duties as assigned.

Skills

Medical terminology

Medical coding

Communication skills

Detail oriented

Organizational skills

HIPAA compliance

Team player

Adaptable to EMR

Education

Associate degree in Health Care Administration or Business Administration OR 3+ years experience in accounts payable/insurance billing

Tools

Word processing

Excel

EMR systems

Billing software

Job description

The Yerington Paiute Tribe is seeking a qualified Billing/Accounts Payable specialist to maintain the fiscal integrity of the PRC program and ensure timely processing of claims, in accordance with clinic policy. The role involves preparing PRC claims and purchase orders, reviewing medical claims with insurers, and re-pricing according to Medicare/Medicaid/MediCal schedules.

Requires associate degree or 3+ years in related field, EMR proficiency, and strong attention to detail.