Revenue Cycle Specialist 2

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.—all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, and clients in three Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com.

PCG Health team helps our clients meet the complex financial, regulatory, and operational challenges of today’s changing health care landscape, so they can provide the best care, most effectively, to those they serve. Our in-depth programmatic knowledge and regulatory expertise help state and municipal health agencies respond to regulatory change, improve access to health care, maximize program revenue, improve business processes, and achieve regulatory compliance.

Services:

• Third Party Administrator Services

• Enhance Health and Public Safety Services

• Claims Processing Services and Solutions

• Consulting and Advisory Services

• Cost Allocation Plans and Time Studies

• Cost Settlement and Supplemental Payment Strategies

• Healthcare Access and Markets

Duties and Responsibilities

• Monitors and Analyzes claim files and paper claims sent to Commercial, Medicare and Medicaid
• Monitors, Analyzes and solves claims stuck in “new status” and not billed out of claims system
• Monitors and works Rejections from 277 files, analyze data for trends and advise supervisor/manager
• Monitors and works denials from 835 files, analyze data for trends and advise supervisor/manager
• Processes QA and mail statements
• Monitors, reviews and works outstanding AR, analyze data for trends and advise supervisor/manager
• Answers provider, submitter, client questions regarding claims and claims related issues
• Performs Quality Assurance Audits
• Enrolls providers in clearinghouse
• Any other duties assigned and relevant to the RCM of the project

Required Skills

• Ability to organize and analyze data
• Ability to execute tasks within a tight deadline
• Ability to properly execute tasks outlined in a process and escalate issues/problems in a timely manner
• Demonstrated accuracy and strong attention to detail
• Proficiency with Microsoft Office, particularly Excel
• Ability to understand industry standards such as 837, 999, 277 and 835 files and rejection and denial management
• Problem solving skills including the ability to identify issues and proactively make recommendations to resolve

Qualifications

• High School Diploma or equivalent required
• 2 - 3 Years Relevant Experience
• Coding Certificate a plus

Supervisory Responsibility

• None

Working Conditions

• Office Setting

The above is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of all duties, responsibilities or skills of personnel so classified.

Compensation:

Compensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience.  As required by applicable law, PCG provides a reasonable range of compensation for this role. In addition, PCG provides a range of benefits for this role, including medical and dental care benefits, 401k, PTO, parental leave, bereavement leave.

PCG does not sponsor newly hired foreign national workers for work authorization, including H-1B sponsorship.

EEO Statement

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.