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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 .

The Contract Support and RCM Analyst will support both the contractual administrative tasks and the entire claim process. The independent contractor will provide contract support through data entry, report extract and analysis, and client support through claim issue research. Additional this position will assist in performing claims processing, medical record audits for all implemented agencies, and assist with other contractual deliverables when needed. Ensures accurate system support through review and updating reference data, contractual metrics, and compliance metrics. Ensures accurate RMC support through internal claim errors and denied claim research results, final remittance advice processing, and medical record reviews that will include discussion with internal management to ensure understanding of results.

Summary of Functions

The Contract Support and RCM Analyst will support both the contractual administrative tasks and the entire claim process. This position will involve contract support through data entry, report extract and analysis, and client support through claim issue research. Additional this position will assist in performing claims processing, medical record audits for all implemented agencies, and assist with other contractual deliverables when needed. Ensures accurate system support through review and updating reference data, contractual metrics, and compliance metrics. Ensures accurate RMC support through internal claim errors and denied claim research results, final remittance advice processing, and medical record reviews that will include discussion with internal management to ensure understanding of results.

Essential Duties and Responsibilities (100%)

• Quickly and effectively researches medical record audits using the internal applications and support documentation to determine compliance with agency specific requirements. Completes the audit results sheet and summaries as necessary or required by the contract. (20%)
• Quickly and effectively researches denied claims to determine root cause of denial and solutions for correction by either the agency or internal fixes to the claiming application or validation routines. (20%)
• Reviews claim files (837s) and remittance advice (835s) for accuracy and completeness. Calls or emails client, agency or other necessary individuals to secure and / or update incorrect or missing information. (10%)
• Reviews all reference files needed by each agency for appropriate claim validation for accuracy and completeness. Calls or emails client, agency or other necessary individuals to secure and / or update incorrect or missing information. (30%)
• Maintains and reviews all internal and external log sheets for accuracy and ensures all data is current and posted timely. (20%)

Organizational Relationships

Reports directly to the ASO Project Manager / Sr. Director of Operations

Key Qualifications and Education Requirements

Claiming or coding certification desired, preferably with a nationally recognized certify organization, either AAPC (American Academy of Professional Coders) and / or AHIMA (American Health Information Management Association).

Understands federal, state, and local claiming requirements and guidance, especially Medicare and Medicaid.

Must understand coding guidance, including CPT (Current Procedural Terminology), HCPCS (Healthcare Common Procedural Coding System), and ICD-10-CM (Internal Classification of Diseases, 10th Edition, Clinical Modification) as it affects the client and / or agency.

Extensive experience in the full claim process particularly regarding Medicaid requirements.

Experience with MS-Office (proficiency in Word, Excel, PowerPoint).

Proficiency in Word to include document structure and formatting

Proficiency in Excel to include Data Validation, Pivot Tables, Formulas, V-lookups, etc.

Experience with Smartsheet creation and use.

Creation and management of multiple types of smartsheets with understanding of organizational creation

Creation of dashboards, alerts, automations, conditional formatting, cell to sheet links, etc.

Understanding Formulas and Functions for data analysis

Excellent oral and written communication required.

Report Deliverables, Presentation preparation and potential delivery to internal and external clients

Preferred candidate will have 5+ years of experience with significant claims processing and medical record auditing.

Must be able to manage clients, both internal and external directly and fairly.

Must be able to manage time independently to ensure that deliverables and tasks meet contractual obligations of delivery dates.

Preferred Skills

Must understand claims processing and be able to read, review, and analyze claim data files (837s) and claim remittance advice (835s) for errors.

Must understand denial codes, their root cause, and how they are corrected.

Must be able to review medical record documents using federal, state, and local guidelines, disseminating the results and the information used to reach the decision in a clear and concise manner.

Must be able to articulate and disseminate information to all parties internal and external in a manner that enhances understanding and reduces further errors.

Must be able to meet contractual deadlines, often multiple deliverables with a short turn-around requirement.

Must be able to manage and complete multiple project tasks, often daily.

Additional Notes

This is a high profile, high energy and demanding environment with extended periods of computer use for claims processing and research. Often requires meeting with client and / or agency team members to discuss results of audits.

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

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As required by applicable law, PCG provides the following reasonable range of compensation for this role : $65hr to $70hr.

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

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.

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.