PRC Claims Analyst, Purchased/Referred Care

Summary of Job Description: Incumbent in this position reviews, evaluates and processes requests for assistance made to the Tribal Purchased/Referred Care program. Minimum Requirements: Knowledge of IHS Purchased Referred Care Programs & Services or ability to learn Knowledge of medical terminology, ICD-10 and CPT coding Knowledge of Medicare, Medicaid and other payers’ reimbursement policies and procedures Intermediate Word and Excel skills (skill level determined by testing) Strong knowledge of claims adjudication or Electronic Health Record (EHR) systems Strong customer service skills Strong organizational skills Ability to maintain strict confidentiality Education, Experience and Training: High school diploma Three (3) years’ experience in medical coding or billing Two (2) years’ experience with either Electronic Health Record (EHR) or electronic billing/payment system OR High school diploma Certified Professional Coder (CPC) or Certified Professional Biller (CPB) or both One (1) year of experience in a customer-facing or data-entry role in any medical office setting The Mohegan Tribal Government is committed to Native American Preference and is an Equal Opportunity Employer.