Senior PRC Claims Analyst – Audit & Repricing

Tuba City Regional Health Care Corporation (TCRHCC); Tuba City (AZ); On-site; USD 60,000 - 90,000; Full time

Job summary

Tuba City Regional Health Care Corporation (TCRHCC) seeks an expert PRC Claims Analyst to monitor program compliance, budgets, and claims accuracy. The role involves high-cost case management, audit, and ensuring proper codes cover provider, diagnosis, and clinic.

The position requires extensive clerical and clinical PRC experience, budgeting skills, and knowledge of PRC processes in a healthcare setting. Navajo Nation preference applies per policy.

Qualifications

• High School Diploma or GED required.
• 5 years of general clerical experience including data entry and customer service.
• 5 years of clinical/medical setting experience.
• 5 years in PRC, Revenue Cycle, or Patient Benefits in any combination.
• 1 year budgeting experience with funds obligation deadlines and spending plans.
• Medical terminology course completion (Navajo Medical Interpreter cert may substitute).
• Experience in repricing PRC claims at Medicare Like Rates.

Responsibilities

• Welcome and greet patients/visitors; document calls and visits; handle inquiries with care.
• Review referrals against EHR to determine PRC eligibility; support decisions.
• Notate approval/denial status to clinic staff; mail referrals and letters.
• Forward referrals for non-TCRHCC patients within 72 hours.
• Maintain case records; input data into PRC management system.
• Educate patients on PRC scheduling; collect required documents; explain rules and eligibility.

Skills

Teamwork

Communication

Multitasking

Dependable

Attention to detail

Education

High School Diploma or GED

Job description

Tuba City Regional Health Care Corporation (TCRHCC) seeks an expert PRC Claims Analyst to monitor program compliance, budgets, and claims accuracy. The role involves high-cost case management, audit, and ensuring proper codes cover provider, diagnosis, and clinic.

The position requires extensive clerical and clinical PRC experience, budgeting skills, and knowledge of PRC processes in a healthcare setting. Navajo Nation preference applies per policy.