Public Consulting Group

Claims Manager

Job Locations US-MA-Boston | US-NH-Portsmouth | US-Home or Remote Position
Posted Date 2 months ago(7/23/2021 2:48 PM)
Job ID
2021-6869
# of Openings
1
Category
Process and Analytics
Type
Regular Full-Time
Practice Area
Health Services

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 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

  • Play a lead role in the implementation of Cognizant’s claims administration tool Qiclink (or RIMS) and related modules, serving as the firm’s subject matter expert with this tool.
  • Knowledge of claims processing, both manually and electronically, using QicLink and associated modules. This includes:
    • Reviews, corrects and appeals claims for timely filing, accuracy and completeness.
    • Processes claims according to set guidelines for payment or denial.
    • Prices claims according to Medicare, Medicaid and custom fee schedules.
    • Audits claims posted within system.
    • Data enters CMS-1500 and UB04 claims into our claiming system.
  • Provides customer support via a toll-free number and email help line, as needed.
  • Participates in desk and compliance review audits for providers.
  • Performs relevant QC on assigned tasks.
  • Manage teams and workloads, while answering questions and providing training, as needed.
  • Assist in defining and implementing service level agreements and performance metrics for projects.
  • Assist in the development and maintenance of standard operating procedures and work flows.

Qualifications

  • Knowledge of QicLink claims system and modules required.
  • Proficient in Microsoft applications; particularly Word, Outlook and Excel.
  • Ability to take initiative, prioritize tasks and manage workflow to meet deadlines.
  • Ability to interpret, comprehend and follow policies and plan provisions.
  • Excellent interpersonal and customer service skills.
  • Excellent oral and written communication skills
  • Problem solving and analytical skills.
  • Ability to work autonomously and within a team.
  • Understanding of healthcare and claims concepts.

Education:  High School degree or equivalent required; Bachelor’s preferred.

 

Experience: 3-5 years related experience, with experience in a leadership capacity

 

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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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