Contract Support and RCM Analyst - Independent Contractor

Contract Support and RCM Analyst

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.

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. This position will also 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. This position will also 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 :

Preferred Skills :

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.

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

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.