Claims Processing Specialist PRC (CS-50002)

Job Details: Job Location: Nespelem - Nespelem, WA, Position Type: Full Time, Salary Range: $22.42 - $27.30Hourly, DescriptionClosing Date: November 13, 2026Position: Claims Processing Specialist (PRC)Salary: $22.42 - $27.30 DOEReports To: PRC AdministratorLocation: Nespelem, WA SUMMARY: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. This position is distinguished by its specialized knowledge of PRC funding regulations, claims adjudication, and coordination of benefits in the context of Indian Health Service delivery. The role requires a high degree of accuracy, confidentiality, and attention to detail, as well as the ability to work independently and in collaboration with other health service and administrative staff. Familiarity with third-party payers, denial management, and medical coding is essential.Qualifications: KNOWLEDGE, SKILLS, AND ABILITIES: High School Diploma or GED required. Associate’s degree in health administration, business, or a related field preferred. Minimum of two (2) years’ experience in medical billing, claims processing, or PRC services. Experience working with tribal health programs or IHS preferred. Certification in medical billing or coding preferred (e.g., CPC, CPB, CBCS). Must possess a valid Washington State driver’s license and be insurable under the Tribe’s vehicle insurance policy. Must pass a criminal background check. Working knowledge of PRC program regulations and federal IHS policies. Proficiency in medical claims processing, including knowledge of CPT, ICD-10, and HCPCS  coding systems. Knowledge of insurance reimbursement systems and coordination of benefits. Familiarity with tribal health programs and funding streams is preferred. Strong analytical and decision-making skills. Proficient in data entry and electronic health records systems. Ability to interpret policies, procedures, and medical documents accurately. 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 resolve billing discrepancies diplomatically and effectively. Ability to work independently and collaboratively with clinical and administrative teams. Ability to prioritize work, multitask, and adapt to changing program requirements. Ability to explain program eligibility, denials, and payment policies to patients and providers.Note: Pursuant to Tribal Policy, if this position is safety sensitive it is subject to pre-employment drug testing. In addition, this position is subject to reasonable suspicion and post-accident drug testing.TRIBAL MEMBER AND INDIAN PREFERENCE WILL APPLY; PREFERENCE WILL ALSO BE GIVEN TO HONORABLY DISCHARGED VETERANS WHO ARE MINIMALLY QUALIFIED.If required of this position, you must possess and maintain a valid Washington State driver’s license and be eligible for the Tribes’ Vehicle Insurance.  In addition, this position may be subject to pre-employment background clearances.  If applicable, these clearances must be maintained throughout employment.INFORMATION: Carla Spencer, Recruiting Manager, Colville Tribal Health Care Authority, Human Resources Office, P.O. Box 150, Nespelem, WA 99155, (509) 846-3774. carla.spencer.hca@colvilletribes.com