Public Consulting Group, Inc. (PCG) provides management consulting and technology services to help public sector education, health, human services, and other government clients achieve their performance goals and better serve populations in need. Founded in 1986 and headquartered in Boston, Massachusetts, PCG has more than 2,200 professionals in 55 offices around the U.S. and in Montreal, the UK and Poland. The firm draws on more than three decades of consulting to public sector clients in all 50 states and Canada to deliver best-practice solutions and measurable results to state and local public agencies, state-operated facilities, and private providers that do business with government agencies. PCG is committed to a diverse workforce which is a reflection of our clients and the people they serve. Our organizational culture attracts and rewards people who are results-oriented and interested in making an immediate impact on their community as well as their own career.

Responsibilities:

• Monitor and manage Medicaid/Managed Care Organization (MCO) eligibility processes, including tracking eligibility trends and preparing files for system import
• Conduct monthly quality assurance processes, including monitoring claiming trends and completing quality checks on a sample of claims being submitted for reimbursement
• Continual focus on compliance and reimbursement optimization
• Manage ad hoc requests, including but not limited to investigating client inquiries and preparing claiming resubmission requests
• Serve as the main point of contact for internal claiming questions/information and collaborate across teams
• Contact the state Medicaid agency support center as appropriate/needed
• Prepare regular and ad hoc reports and assist with the creation of client-facing agendas/materials
• Gain a detailed understanding of Medicaid and claiming processes and the appropriate application of policy to processes
• Prepare for, and participate in, meetings focused on claiming operations and optimization
• Learn and become proficient with PCG systems, including overall management, updates, and integration/interaction

Required Skills:

• • Ability to evaluate, prioritize, and perform operational and analytical tasks
  • Ability to build and maintain working relationships with internal and external contacts
  • Strong Microsoft application skills including Word, Excel, PowerPoint, Access, etc.
  • Prior experience with a task management system a plus (e.g., Asana or Jira)
  • Excellent organizational and communication skills
  • Ability to work both in a team environment and autonomously
  • Existing knowledge or experience with state government, health insurance payment systems (particularly Medicaid and MCOs), and/or cost accounting are highly advantageous

Education: Bachelor's degree

Experience: 5 years of experience in operations and/or data analysis preferred

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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.