Claims Processing Specialist PRC (CS-50002)

CONFEDERATED TRIBES OF THE COLVILLE RESERVATION•Coulee City, WA

3d•$22 - $27

About The Position

The Claims Processing Specialist is responsible for accurately and promptly processing claims submitted to the Purchased/Referred Care (PRC) program. The role includes verifying patient eligibility, ensuring compliance with federal PRC regulations, coordinating with providers and vendors, and maintaining detailed claim records for audit and reporting purposes. The position requires working knowledge of medical billing codes, insurance reimbursement processes, and PRC guidelines governed by the Indian Health Service and tribal policies. It is distinguished by specialized knowledge of PRC funding regulations, claims adjudication, and coordination of benefits in the Indian Health Service delivery context. The specialist must demonstrate accuracy, confidentiality, and attention to detail, and work both independently and collaboratively with health service and administrative staff. Familiarity with third-party payers, denial management, and medical coding is essential. The position is located in Nespelem, Washington, reports to the PRC Administrator, and is full-time. The listed salary range is $22.42–$27.30 per hour, DOE. The application closing date is November 13, 2026. If the position is safety-sensitive, pre-employment drug testing applies, as well as reasonable-suspicion and post-accident drug testing. Tribal member and Indian preference applies, and preference is also given to honorably discharged veterans who are minimally qualified.

Requirements

High school diploma or GED.
At least two years of experience in medical billing, claims processing, or PRC services.
Working knowledge of PRC program regulations and federal IHS policies.
Proficiency in medical claims processing, including CPT, ICD-10, and HCPCS coding systems.
Knowledge of insurance reimbursement systems and coordination of benefits.
Strong analytical and decision-making skills.
Proficiency in data entry and electronic health records systems.
Ability to accurately interpret policies, procedures, and medical documents.
Effective written and verbal communication skills.
Ability to maintain confidentiality and comply with HIPAA regulations.
Ability to work under pressure and meet strict deadlines.
Ability to work independently and collaboratively with clinical and administrative teams.
Ability to prioritize work, multitask, and adapt to changing program requirements.
Valid Washington State driver's license and eligibility for the Tribes' vehicle insurance, if required for the position.
Must pass a criminal background check; any applicable pre-employment background clearances must be maintained throughout employment.
If the position is safety-sensitive, must undergo pre-employment drug testing and may be subject to reasonable-suspicion and post-accident drug testing.

Nice To Haves

Associate's degree in health administration, business, or a related field.
Experience working with tribal health programs or IHS.
Certification in medical billing or coding, such as CPC, CPB, or CBCS.
Familiarity with tribal health programs and funding streams.

Responsibilities

Process claims submitted to the Purchased/Referred Care (PRC) program accurately and promptly.
Verify patient eligibility.
Ensure claims processing complies with federal PRC regulations and applicable Indian Health Service and tribal policies.
Coordinate with providers and vendors.
Maintain detailed claim records for audit and reporting purposes.
Apply medical billing codes, insurance reimbursement processes, claims adjudication, and coordination-of-benefits knowledge.
Resolve billing discrepancies diplomatically and effectively.
Explain program eligibility, denials, and payment policies to patients and providers.
Maintain confidentiality and comply with HIPAA regulations.
Work independently and collaboratively with clinical and administrative teams, while prioritizing work and meeting deadlines.