Billing Claims Manager

Overview About Public Consulting Group Public Consulting Group, Inc.

(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 and headquartered in Boston, Massachusetts, PCG has over 2,500 professionals in more than 60 offices worldwide.

PCG’s Human Services practice helps state, county, and municipal human services agencies to achieve their performance goals in order to better serve populations in need.

PCG’s seasoned professionals offer proven solutions to help agencies design programs, services, and systems; increase program revenue; cut costs; and improve regulatory compliance with state and federal regulations.

To learn more, visithttp://www.publicconsultinggroup.com/humanservices/.

Responsibilities + Leads and directs the work of Claims Analysts + Directs daily operations of billing contract requirements and project work plans + Creates and manages on-going schedule for claims submission across all projects nationally + Performs research and analysis to determine best practices and suggest how to improve current practices and respond to internal and external client inquiries.

Responsible for providing, leading, managing, coaching, and guiding all associates assigned to the contract/department, maintain a positive, effective communication with providers, supervisors, peers, and subordinates.

+ Conducts user acceptance testing and regression testing on systems + Develops recommendations to solve issues related to business systems in a collaborative environment with multiple stakeholders.

+ Reviews feature request documents and business requirements developed by other staff to ensure accuracy, consistency, and depth of analysis.

+ Provides consultation to staff on Medicaid and commercial insurance policy, operations, and internal system functionality.

+ Establishes and implements organizational policies, offers guidance on appropriate handling of complex and/or high-volume claims and claim denial research.

+ Acts autonomously and creatively in solving complex problems, and by applying seasoned knowledge, skills, and experience to quickly come up with creative value-add solutions.

+ Serves as a subject matter expert on areas directly affecting the contract, client, and implemented agencies.

+ Performs special projects as directed.

Qualifications Required Skills + Ability to evaluate and prioritize tasks effectively with minimal oversight.

+ Solid technical competency in systems and strong organizational skills.

+ Robust data skills, secure data handling, and understanding of data fidelity best practices.

+ Deep understanding of relational databases.

+ Detailed understanding of Medicaid and commercial insurance policy and operations.

+ Ability to read and understand standard EDI formats (837, 277, 835, etc.) + Ability to quickly understand and implement new technical and policy requirements.

+ Microsoft Access/Excel skills required, SQL query/analysis skills a plus.

+ Comprehensive knowledge of the overall departmental function.

Qualifications + Bachelor’s degree + Experience with state and federal Medicaid policies, concepts, practices, and procedures.

+ 8 years of relevant experience; 2-3 years of supervisory experience.

#LI-MB1 #LI-Remote 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.

Connect With Public Consulting Group!

Connect with Public Consulting Group > Job LocationsUS Posted Date1 week ago(1/20/2022 4:11 PM) Job ID 2022-7609 # of Openings 1 Category Management Type Regular Full-Time Practice Area Human Services Public Consulting Group is an equal opportunity employer.

All qualified applicants receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, protected veteran status, or status as a qualified individual with a disability.

VEVRAA Federal Contractor.