Public Consulting Group

Operations Analyst

Job Locations US-NH-Portsmouth | US-MA-Boston | US-Home or Remote Position | US-NH-Portsmouth | US-RI-Providence
Posted Date 1 month ago(5/3/2021 10:08 AM)
Job ID
2021-6469
# of Openings
1
Category
Operation Support
Type
Regular Full-Time
Practice Area
Health Services

Overview

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 Health practice offers in-depth programmatic knowledge and regulatory expertise to 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. Using industry best practices, PCG’s Health team helps organizations deliver quality services with constrained resources to promote improved client outcomes. To learn more, visit http://www.publicconsultinggroup.com/health/.

Responsibilities

  • Configure claims system according to benefit plans and provider contracts and fee schedules
  • Validate member benefits against the benefit matrix
  • Update functional specifications according to change order from client
  • Analyzing and testing data on different billing and membership functionality manually and writing queries on database for validating data
  • Responsible for interfacing with the Claims Department, client, and IT teams to identify business requirements, communicate and resolve claims issues, and project manage resolution tasks.
  • Update and maintain benefit and system configuration settings in our claims, billing, and data intermediary processing systems
  • Manage the system to complete the full production schedule for billing, processing, reporting and paying claims
  • Support multiple projects and teams by analyzing system performance, data quality, and performing root cause analysis on any issues related to our production systems. This includes claiming, eligibility, authorization and billing
  • Provider management, including provider setup and updates in the system, as well as handling contract and fee schedule updates
  • Identify and report on inaccurate or missing data
  • Perform system testing, including creating test cases
  • Create and update training materials, and Policies and Procedures as necessary
  • Provide client and internal reports as requested.
  • Create process flows, and participate in process improvement projects
  • Work within a team to complete special projects, or perform other duties as necessary to meet client deadlines

 

 

Qualifications

  • Medicare and Mass Medicaid experience preferred
  • Excellent verbal and written communication skills
  • Ability to manage and coordinate several ongoing assignments while meeting deadlines and performance goals
  • Strong analytical skills
  • Ability to work independently or with a team
  • Attention to detail
  • Experience with Microsoft Office applications, specifically Excel, Word and Access
  • Experience with SQL Management Studio
  • Bachelor's degree or 4 years relevant healthcare experience preferred
  • Remote work is potential for this role.  Post COVID, candidate must be able to commute to Portsmouth office on occasion.

 

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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.

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