Billing Specialist

Job Description

Job Description

Health Pros Northwest  is seeking a Billing Specialist to assist with the local Tribal Health Clinic located in Skokomish, WA. This would be a full-time, direct hire position. The clinic's hours are Monday-Friday 8am to 5pm

NATURE OF WORK: This is a dual role position responsible for Purchased Referred Care (PRC) 
and Medical Billing functions within the Health Department. The PRC program is funded and 
regulated through Indian Health Service (IHS) and is intended to supplement and complement other 
available healthcare resources for eligible participants. This position supports PRC eligibility, referral 
coordination, claims and Explanation of Benefits (EOB) review, prior authorization processes, 
payment review, and medical billing functions to ensure compliance with tribal, IHS, payer, state, and 
federal requirements while working closely with patients, providers, outside facilities, insurance 
carriers, and internal staff to support timely access to care, accurate claims processing, appropriate 
reimbursement, and compliance with payer of last resort requirements. 

QUALIFICATIONS: 
1. High school diploma or GED. 
2. Minimum of two (2) years of experience working as a PRC Specialist in a tribal health or IHS 
facility. 
3. Minimum of two (2) years of experience working in a medical office, clinic, hospital, or 
healthcare billing environment. 
4. Minimum of two (2) years of experience using an electronic health record and/or medical billing 
system . 
5. Working knowledge of insurance billing, claims processing, EOB review, prior authorization 
processes, and reimbursement practices. 
6. Working knowledge of ICD-10-CM, HCPCS, and CPT coding. 
7. Knowledge of HIPAA, confidentiality, and healthcare privacy requirements. 
8. The candidate must have a valid driver’s license and be eligible for the Tribe’s automobile 
insurance. 
9. Must be able to work in a team environment. 
10. Strong organizational, communication and interpersonal skills preferred.
11. The selected candidate must successfully complete a pre-employment drug screen test, and 
a complete background investigation, including relevant criminal history, prior to 
employment.

PREFERRED QUALIFICATIONS:

1. Associate degree in Accounting, Medical Office Technology, Health Information, Business, or 
related field. 
2. Experience using IHS-RPMS, CHS, RCIS, or related IHS/tribal health systems. 
3. Medical billing and coding certification. 
4. Accounts payable, payment processing, or healthcare finance experience. 
5. Experience working with tribal health programs, third-party liability, Medicaid, Medicare, and 
commercial insurance.