Claims Processing Specialist PRC

The Claims Processing Specialist is responsible for the accurate and timely processing of claims submitted to the Purchased/Referred Care (PRC) program. This role involves verifying patient eligibility, ensuring compliance with federal PRC regulations, coordinating with providers and vendors, and maintaining detailed records of claims for audit and reporting purposes. The position requires a working knowledge of medical billing codes, insurance reimbursement processes, and the PRC program guidelines governed by the Indian Health Service and tribal policies.