PRC Program Lead: Healthcare Claims & Compliance

Confederated Tribes of Siletz Indians; Siletz (OR); On-site; USD 46,085 - 65,637; Full time

Job summary

The Confederated Tribes of Siletz Indians seek a Purchase Referred Care Manager to supervise Healthcare Reimbursement Technicians and manage daily PRC operations in Siletz, Oregon. You will oversee claims processing, ensure policy compliance, and prepare performance and financial reports for the department.

The role requires leadership, accuracy in billing, and the ability to coordinate with clinics and providers. Prior supervision in PRC or medical billing is essential.

Qualifications

• Associate’s degree in healthcare administration or related field.
• Four years’ experience in medical billing or healthcare reimbursement.
• Two years of supervisory experience.

Responsibilities

• Supervise and train Healthcare Reimbursement Technicians.
• Monitor PRC program documents, provider agreements, and contracts for compliance.
• Approve program expenditures and authorize PRC claim payments; oversee reconciliations.
• Provide backup coverage for PRC Tech II and perform duties as needed.
• Prepare monthly, quarterly, and annual reports focusing on metrics and expenditures.
• Respond to requests professionally and maintain appropriate demeanor.
• Aid in developing enhanced workflow processes and drive cost-effective improvements.
• Coordinate with internal departments and external providers to resolve escalated issues.
• Coordinate with clinic patients to resolve escalated issues.
• Process CHEF reimbursement cases for catastrophic expenses.
• Stay updated on regulations and best practices; implement changes as needed.
• Maintain program guidelines and train staff in patient accounts.

Skills

Medical billing

Healthcare reimbursement

Supervisory experience

Regulatory compliance

Leadership

Education

Associate’s degree in healthcare administration or related field

Tools

NextGen EHR/EMR

Job description

The Confederated Tribes of Siletz Indians seek a Purchase Referred Care Manager to supervise Healthcare Reimbursement Technicians and manage daily PRC operations in Siletz, Oregon. You will oversee claims processing, ensure policy compliance, and prepare performance and financial reports for the department.

The role requires leadership, accuracy in billing, and the ability to coordinate with clinics and providers. Prior supervision in PRC or medical billing is essential.