Program Specialist - Purchase Preferred Care

Location:

Longview, WA Exit Disclaimer: You Are Leaving www.ihs.gov

Type: Tribal Salary Range: $56,472 to $65,000 / Per Year Open Period: 8/4/2026 to 8/18/2026 Summary: Working for the Cowlitz Indian Tribe (CIT) comes with a competitive compensation package designed to support work-life balance. Employees enjoy separate sick and vacation accruals, comp-time, and 15 paid holidays annually, including an additional paid cultural day. Many full-time employees benefit from premium-free medical plans, fair wages with annual increase opportunities, and a meaningful career serving the Cowlitz people. CIT fosters an engaging and collaborative work environment while offering a robust total compensation package.

Coordinates Purchased/Referred Care (PRC) services by determining patient eligibility, reviewing and processing referrals and prior authorizations, coordinating access to healthcare services, and processing claims for payment and denials in accordance with Cowlitz Indian Tribe Health & Human Services (CITHHS) policies and procedures and PRC program requirements. Educates members and providers regarding PRC eligibility, alternate resources, and program requirements to ensure timely access to care. Maintains accurate records, protects confidential information (HIPAA), and provides exceptional customer service while supporting the mission, vision, and values of the Cowlitz Indian Tribe. More info about area: https://cowlitz.org/ Exit Disclaimer: You Are Leaving www.ihs.gov

Duties: • Authorizes medical, dental, and vision services for eligible medical beneficiaries and maintains records of all services purchased and payments made. • Assists and educates clients on program registration and enrollment processes, including completing applications, meeting program requirements, and accessing alternate resources. • Reviews and determines client eligibility for PRC program services and coordinates access to available benefits to ensure clients receive services and resources for which they qualify. • Maintains billing and payment records, communicates with clients and providers on payment application procedures, claims processing, and status updates. • Maintains accurate patient records to include eligible data, invoices of all medical bills paid, and referrals. • Responds to requests for information from vendors concerning payment of bills promptly and in accordance with tribal policies and procedures. • Participates in training and ongoing program evaluation to ensure PRC program is meeting the needs of clients. • Provides education to clients, vendors, and staff on PRC policies, appeal processes, alternate resources, and eligibility requirements. • Processes and monitors prior authorizations; coordinates with patients and providers to obtain required information and follows cases through payment completion. • Tracks, records, and reports on client and program data as requested. • Reviews, prepares, and submits Purchased/Referred Care (PRC) claims for payment in accordance with CITHHS regulations, • Manages incoming telephone and voicemail communications by screening inquiries, determining needs, and routing calls and messages to the appropriate personnel or department. • Participates in staff meetings as needed. • Adapts to changes in safety protocols and procedures. • Completes Information Security System Awareness (ISSA) training as required. • Contributes to a team effort and accomplishes related results as required. • Performs other duties as assigned. Qualifications: Minimum Qualifications: • High School Diploma/GED; associate''s degree preferred. • Five (5) years of related experience. • A combination of relevant education and related work experience may be considered. • A valid driver''s license is required when driving vehicles for work-related purposes. • Obtain and maintain BLS/CPR and AED certifications. • Must be able to successfully pass a background screening/investigation according to the established requirements below. Tribal preference in accordance with Cowlitz Indian Tribe Code and CIT Employee Policies and Procedures Handbook shall apply to all positions. All positions are required to adhere to CIT''s established safety policies regarding vaccine requirements and personal protective equipment (PPE). Work Type: Permanent, Full Announcement #: Cowlitz-2026-PSPRC Who May Apply? All Groups of Qualified Individuals Get Details & Apply: https://cowlitz.org/index.php/tribal-job-listings Exit Disclaimer: You Are Leaving www.ihs.gov